不同体表标志法确定鼻咽通气道型号的准确性

Accuracy of different anatomic landmark methods in determining size of nasopharyngeal airway

目的评价不同体表标志法确定鼻咽通气道型号的准确性.方法择期在镇静-清醒-镇静麻醉下行术中唤醒幕上肿瘤切除术患者52例,年龄16~60岁,ASA分级Ⅰ-Ⅲ级,BMI 18~30kg/m^2,性别不限.分别测量患者鼻尖-右侧耳屏、鼻尖-右侧下颌角、甲颏间距的距离,并在鼻插异型气管导管上做相应标记.患者去枕平卧,给予2%利多卡因鼻腔粘膜表面麻醉,咪达唑仑、丙泊酚及右美托咪定静脉输注镇静.当患者警觉与镇静评分达2或3分时,经鼻置入异型气管导管,且在每位患者的置管深度先后达到上述3种标记深度时,以视频软镜检查导管尖端位置,并记录为:会厌上,即导管尖端位于软腭游离缘与会厌之间;会厌下,即导管尖端向下超越会厌上缘.结果依据鼻尖-耳屏法,14例患者(27%)导管尖端在会厌上,38例患者(73%)导管尖端在会厌下;依据鼻尖-下颌角法,31例患者(60%)导管尖端在会厌上,21例患者(40%)导管尖端在会厌下;依据甲颏间距法,52例患者(100%)导管尖端在会厌上.甲颏间距法较另2种体表标志法确定的置入深度,导管尖端位于会厌上的比率升高(P<0.01).结论依据甲颏间距体表标志法确定鼻咽通气道型号的准确性更高.

Objective To evaluate the accuracy of different anatomic landmark methods in determining the size of nasopharyngeal airway.Methods Fifty-two patients of both sexes,aged 16-60 yr,of American Society of Anesthesiologists physical statusⅠ to Ⅲ,with body mass index of 18-30 kg/m^2,scheduled for elective awake craniotomy for supratentorial tumors under sedation-awake-sedation anesthesia,were included.For each patient,the distance from the apex of nose to the right tragus(NT),distance from apex of nose to the right mandibular angle(NM),and thyro-mental distance(TM)were measured and marked on a transnasal tube correspondingly.The patients were placed in supine position without pillow,topical anesthesia(nasal mucosal surface)was performed with 2% lidocaine,and patients were sedated with midazolam,propofol and dexmedetomidine.When Observer's Assessment of Alertness/Sedation Scale score was 2 or 3 points,the tube was transnasally inserted to each marked depth.When the three marked depths mentioned above were reached,the positions of the tube's tip were checked using a fiberoptic bronchoscope and recorded as:above epiglottis(the tip of the tube was placed between the epiglottis and the free edge of soft palate)or below epiglottis(the tip of the tube placed at or beyond the epiglottis).Results When the depth reached the NT mark,the tube's tip was above epiglottis in 14 cases(27%),and the tube's tip was below epiglottis in 38 cases(73%).When the depth reached the NM mark,the tube's tip was above epiglottis in 31 cases(60%),and the tube's tip was below epiglottis in 21 cases(40%).When the depth reached the TM mark,the tube's tip was above epiglottis in 52 cases(100%).Compared with the NM and NT methods,the TM method had a higher probability with the tube's tip above epiglottis when used to determine the depth of insertion(P<0.01).Conclusion TM anatomic landmark method provides higher accuracy in determining the size of nasopharyngeal airway.