可视喉镜联合纤支镜在老年全麻胸外科患者困难气道双腔气管插管中的应用

Application of Visible Laryngoscope Combined with Fiber Bronchoscope on Double Lumen Tube Intubation of Difficult Airway in Elderly Patients Undergoing General Anesthesia in Thoracic Surgery

目的:探讨可视喉镜联合纤维支气管镜(简称纤支镜)在老年全麻胸外科患者困难气道双腔气管插管中的应用效果。方法:将本院151例术前Mallampati分级为3、4级的老年全麻胸外科困难气道患者作为研究对象,根据自愿原则将其分为联合镜组(n=77,可视喉镜联合纤支镜行双腔气管插管)与纤支镜组(n=74,纤支镜行双腔气管插管),对比两组一次插管成功率、插管时间、手术不同时间点生命体征及并发症发生情况。结果:联合镜组一次插管成功率高于纤支镜组(P<0.05),插管时间短于纤支镜组(P<0.05);联合镜组T2、T3、T4时间点心率(HR)、平均动脉压(MAP)均低于纤支镜组(P<0.05),T0~T4过程中HR、MAP变化幅度均小于纤支镜组;联合镜组并发症发生率低于纤支镜组(P<0.05)。结论:可视喉镜联合纤支镜在老年全麻胸外科患者困难气道双腔气管插管中的应用效果较好,可以提高一次插管成功率,维持患者生命体征稳定。

Objective: To explore the application effect of visible laryngoscope combined with fiber bronchoscope on double lumen tube intubation of difficult airway in elderly patients undergoing general anesthesia in thoracic surgery. Method: A total of 151 patients with preoperative Mallampati grading at grade 3, 4 and difficult airway who underwent general anesthesia in thoracic surgery of our hospital were enrolled as study objects. According to voluntary principle of patients, they were divided into combined endoscope group(n=77, double lumen tube intubation by visible laryngoscope combined with fiber bronchoscope) and fiber bronchoscope group(n=74, double lumen tube intubation by fiber bronchoscope). The success rate of one-time intubation, intubation time, vital signs at different time points of surgery and complications were compared between two groups. Result: The success rate of one-time intubation in combined endoscope group was higher than that in fiber bronchoscope group(P<0.05), while intubation time was shorter than that in fiber bronchoscope group(P<0.05). At T2, T3, T4, HR and MAP in combined endoscope group were lower than those in fiber bronchoscope group(P<0.05). From T0 to T4, the change amplitudes of HR and MAP in combined endoscope group were less than those in fiber bronchoscope group. The total incidence of complications in combined endoscope group was lower than that in fiber bronchoscope group(P<0.05). Conclusion: Application effect of visible laryngoscope combined with fiber bronchoscope is relatively better on double lumen tube intubation of difficult airway in elderly patients undergoing general anesthesia in thoracic surgery. It can improve success rate of one-time intubation, and maintain vital signs of patients.