纤支镜引导表面麻醉在插管困难的喉癌患者清醒插管中的应用

Application of surface anesthesia guided by fiberoptic bronchoscopy in awake intubation of laryngeal carcinoma patients with difficult intubation

目的研究纤维支气管镜引导的表面麻醉在经口清醒气管插管中的应用效果。方法选择择期行全麻下喉癌手术且预期气管插管困难的患者60例,随机分为两组,A组采用口咽部表面麻醉加纤维支气管镜引导的表面麻醉,B组采用口咽部表面麻醉加环甲膜穿刺气道内表面麻醉,然后进行纤维支气管镜引导下的经口清醒气管插管。记录插管时间、局麻时患者呛咳评分、插管时恶心评分、气管导管置入时患者呛咳评分、插管过程中的舒适度评分以及插管成功后患者对气管导管耐受评分;记录入室后(T0)、局麻完成后(T1)、气管导管进入声门(T2)、气管插管完成后注射全麻药物前(T3)的氧饱和度(saturation of pulse oxygen,SpO2)、平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)。结果两组插管时间无明显差异。A组局麻呛咳评分、插管时恶心评分、气管导管置入到位时呛咳评分、患者舒适度评分、导管耐受评分均较B组低(P<0.05)。在T0及T1时,两组患者HR及MAP均无明显差异。在T2及T3时,A组患者HR及MAP较B组患者低(P<0.05)。所有时间点两组SpO2无明显差异。结论相比于传统的环甲膜穿刺气道内表面麻醉,纤维支气管镜引导的表面麻醉能为喉癌患者提供更好的清醒气管插管条件,患者满意度更高。

Objective To study the effect of surface anesthesia guided by fiberoptic bronchoscope on awake orotracheal fiberoptic intubation.Methods Sixty patients with elective laryngeal surgery under general anesthesia and with tracheal intubation difficulties,were randomly divided into two groups:group A received pharyngeal surface anesthesia and surface anesthesia guided by fiberoptic bronchoscope,and group B received pharyngeal surface anesthesia and airway surface anesthesia by cricothyroid membrane puncture.The patient was then intubated through the mouth guided by fiberoptic bronchoscope.Intubation time,cough score of patients during surface anesthesia,nausea,cough score of patients during intubation,comfort score during intubation,and tolerance score and patient comfort score after intubation were recorded.Oxygen saturation(SpO2),average arterial pressure(MAP)and heart rate(HR)were recorded after enter the operating room(T0),after surface anesthesia(T1),after tracheal tube entry into glottis(T2),and after intubation and before injection of general anesthesia(T3).Results The cough score of patients during local anesthesia,nausea score during intubation,cough score of patients during intubation,comfort score during intubation,and tolerance score after intubation in group A were all lower than those in group B(P<0.05).At T0 and T1,there was no significant difference in HR and MAP between the two groups.At T2 and T3,HR and MAP in group A were lower than those in group B(P<0.05).There was no significant difference in SpO2 between the two groups at all time points.Conclusion Surface anesthesia guided by fiberoptic bronchoscope can provide better intubation conditions and higher patient satisfaction for patients with laryngeal cancer,compared with traditional endotracheal surface anesthesia by cricothyroid membrane puncture.