呼气末CO2监测在口腔颌面外科困难气管插管中的应用效果评价

Application of end tidal carbon dioxide monitoring in difficult tracheal intubation during oral and maxillofacial surgery

目的:评价纤维支气管镜联合呼气末CO2监测用于口腔颌面外科困难气道患者经鼻腔气管插管的效果。方法:选择2018年11月—2019年1月口腔颌面外科预计困难气道的全身麻醉患者60例,ASA分级Ⅰ~Ⅱ级,随机分为2组(n=30):对照组在保留患者自主呼吸下使用纤维支气管镜引导经鼻腔气管插管;试验组在保留患者自主呼吸下,使用呼气末CO2监测联合纤维支气管镜经鼻腔气管插管。记录首次气管插管成功率、使用纤维支气管镜气管插管时间,尝试次数以及气管插管并发症发生率。采用GraphPad Prism 6软件包对2组资料进行t检验、χ^2检验,筛选差异指标。结果:2组首次气管插管成功率无显著差异(对照组为90.0%,试验组为93.3%,P=0.2196);2组平均纤维支气管镜插管尝试次数无显著差异[对照组为(1.2±0.2)次、试验组为(1.1±0.1)次,P=0.6451];试验组使用纤维支气管镜插管时间显著低于对照组[对照组为(29.5±2.3)s,试验组为(15.8±1.2)s,P=0.0192];插管过程中,2组心动过速(HR>100次/min)发生率无显著差异(对照组为6.6%、试验组为3.3%,P=0.1746);2组插管时血压升高(高于基础血压20%)发生率无显著差异(对照组为10.0%,试验组为6.7%,P=0.2541);试验组插管时氧饱和度下降(SpO2<90%)发生率显著低于对照组(对照组为13.3%,试验组为6.7%,P=0.0412);试验组鼻出血的发生率显著低于对照组(对照组为16.7%,试验组为6.7%,P=0.0224);2组术后咽痛的发生率无显著差异(对照组为6.7%,试验组为3.3%,P=0.1652);2组均未发生术后声音嘶哑;2组术后不良记忆的发生率无显著差异(对照组为6.7%,试验组为3.3%,P=0.1652)。结论:呼气末CO2监测联合经鼻腔纤维支气管镜引导气管插管可缩短气管插管时间,减少插管时氧饱和度下降及鼻出血发生率,提高气管插管效率和安全性。

PURPOSE:To evaluate the efficacy of fiberoptic bronchoscopy combined with end-tidal carbon dioxide monitoring for endotracheal intubation in patients with difficult airway in oral and maxillofacial surgery.METHODS:Sixty patients with expected difficult airway under general anesthesia undergoing oral and maxillofacial surgery from November 2018 to January 2019 were selected.ASA grade Ⅰ~Ⅱ patients were randomly divided into two groups(n=30).Patients in the experimental group received end-tidal carbon dioxide monitoring combined with fiberoptic bronchoscopy for transnasal endotracheal intubation under the condition of preserving patients'spontaneous breathing,while patients in the control group only received fiberoptic bronchoscopy for the procedures.The success rate of the first endotracheal intubation,the duration of endotracheal intubation with fiberoptic bronchoscopy,the number of attempts,and the incidence of endotracheal complications were recorded.GraphPad Prism 6 was used for statistical analysis.RESULTS:A total of 60 patients were included and 60 were actually completed.There was no significant difference in the success rate of first endotracheal intubation between the two groups(90.0%for the control group and 93.3%for the experimental group,P=0.2196).There was no significant difference in the average number of intubation attempts between the two groups(1.2±0.2 times in the control group and 1.1±0.1 times in the experimental group,P=0.6451).The intubation time in the experimental group was significantly lower than that in the control group[(29.5±2.3)s in the control group and(15.8±1.2)s in experimental group,P=0.0192].During intubation,there was no significant difference in the incidence of tachycardia(HR>100 times/min)between the two groups(6.6%for the control group and 3.3%for the experimental group,P=0.1746).There was no significant difference in the incidence of increased blood pressure(20%higher than the essential blood pressure)during intubation between the two groups(10.0% in the control group and 6.7% in the experimental group,P=0.2541).The incidence of oxygen saturation decrease(SpO2<90%)in the experimental group was significantly lower than that in the control group(13.3% in the control group and 6.7% in the experimental group,P=0.0412).The incidence of epistaxis was significantly lower in the experimental group than in the control group(16.7% in the control group and 6.7% in the experimental group,P=0.0224).There was no significant difference in the incidence of postoperative pharyngeal pain between the two groups(6.7% in the control group and 3.3% in the experimental group,P=0.1652).Postoperative hoarseness did not occur in either group.There was no significant difference in the incidence of postoperative adverse memory between the two groups(6.7% in the control group and 3.3% in the experimental group,P=0.1652).CONCLUSIONS:End-tidal carbon dioxide monitoring combined with endotracheal intubation through nasal fiberoptic bronchoscopy can shorten the duration of endotracheal intubation,decrease oxygen saturation during intubation and reduce the incidence of epistaxis,thus improving the efficiency and safety of endotracheal intubation.