超声定位引导在声门显露困难患者气管插管中的应用

Clinical study of ultrasound guided in locating endotracheal intubation in patients with difficult glottis exposure

目的:观察Mallampati分级大于Ⅲ级患者使用超声引导定位气管导管位置的临床效果。方法:选取择期手术患者60例,根据数字表法随机分组为对照组(C组)和超声组(U组)。常规麻醉诱导后,两组患者均经口插入树胶弹性探条,C组根据气管环的振动确定在位后将导管沿探条顺行置入,并以PETCO2确认导管位置;U组将套在探条外且套囊内注入2 mL生理盐水的气管导管推送入声门下,同时行超声察看套囊的位置。观察并记录两组患者首次插管成功率、无通气时间、定位完成耗费的时间、喉镜暴露时C/L分级、导管位置的判断、深度调整及插管相关并发症。结果:两组首次插管成功率比较,差异无统计学意义(P>0.05);U组的无通气时间明显低于C组(P<0.05);插管后,U组导管深度适宜比率明显高于C组,调整次数明显少于C组(P<0.05);U组导管定位时间明显低于C组(P<0.05);两组C/L喉镜暴露分级和插管不良并发症比较,差异无统计学意义(P>0.05)。结论:超声定位引导用于声门暴露困难患者气管插管,能降低无通气时间,准确判断导管位置及深度,为临床定位导管提供新的方法。

Objective:To observe the clinical effect of ultrasound guided location of tracheal tube in patients with MallampatiⅢ.Methods:60 patients scheduled from selective surgery were randomly divided into two groups:ultrasound group(group U)and control group(group C).After induction of general anesthesia,the patients of two groups were inserted into the gum elastic bougie(GEB)through the oral,catheter was placement along the bougie according to the vibration of the tracheal ring in the group C,and the location of the tube was confirmed with PETCO2.The cuff of endotracheal tube which wrapped around the bougie filled with 2 mL saline was inserted under the glottis in the group U,while the position of the endotracheal tube cuff was confirmed by ultrasound.The following information was recorded:success rate of first endotracheal intubation,time without ventilation,time to complete localization,C-L grading,judgment of tube position and depth adjustment and complications related endotracheal intubation.Results:There was no significant difference in the success rate of first intubation between the two groups(P>0.05).The time without ventilation in group U was significantly less than that in group C(P<0.05).Proportion of suitable tube depth in the group U was significantly higher than that in group C,and the ratio of tube adjustment was significantly lower than that in group C after intubation(P<0.05).The time of location by fiber bronchoscope in group U was significantly lower than that in group C(P<0.05),and there was no difference in C/L grading and complications after intubation between the two groups(P>0.05).Conclusion:Ultrasound guided endotracheal intubation in patients with difficult glottis exposure can reduce the time without ventilation and accurately located the position and depth of the endotracheal tube and provide a new way for clinical positioning.