国产明视软镜联合硬膜外导管表面麻醉在清醒困难插管中的应用

Domestic video intubationscope combined with topical anesthesia through epidural catheter in intubation in difficult airway consciousness

目的:探讨国产明视软镜联合硬膜外导管表面麻醉在困难气道清醒插管中的应用效果。方法:选取我院2018年1月-2019年12月收治的60例困难气道患者为研究对象,按照随机数字表分为对照组(n=30例)、观察组(n=30例)。对照组采取FOB联合环甲膜穿刺表面麻醉插管,观察组采取国产明视软镜联合硬膜外导管表面麻醉插管,记录入室后5 min(基础值,T 0)、气管导管进入气管(T 1)、插管完成5 min(T 2)时的HR、MAP、SPO 2、皮质醇、去甲肾上腺素、肾上腺素浓度;记录患者插管时呛咳、恶心、体动等发生情况;一次插管成功率,术后第1天随访患者插管并发症及麻醉满意度评价。结果:两组一次插管成功率差异无统计学意义(P>0.05);两组在T 1、T 2时的HR、MAP、应激反应指标均高于T 0(P<0.05);组间比较,T 1、T 2时对照组的HR、MAP、应激反应指标均高于观察组(P<0.05);插管时呛咳、恶心、体动观察组明显少于对照组(P<0.05);观察组在术后第1天患者随访并发症发生率及麻醉方法的满意度均优于对照组(P<0.01)。结论:国产明视软镜(DVIS)联合硬膜外导管表面麻醉在困难气道清醒插管中可取得很好的应用效果,可显著抑制清醒插管应激反应,患者的舒适度及满意度大大提高。

Objective:To investigate the application of Domestic video intubationscope combined with Topical Anesthesia through Epidural Catheter in intubation of difficult airways.Methods:A total of 60 patients with difficult airways admitted to our hospital from January 2018 to December 2019 were selected as the research subjects.They were divided into the control group(30 cases)and the observation group(30 cases)according to the random number remainder grouping method.The control group was intubated with FOB combined with cyclomethylenema.The observation group adopted Domestic Video Intubationscope combined with Topical Anesthesia through Epidural Catheter for intubation.Then record that the success rate of one intubation,the HR,MAP,SPO 2,Cortisol,Noradrenalin and Epinephrine concentrations were recorded at 5 min after entering the room(basic value,T 0),the tracheal catheter entered the trachea(T 1),5 min after intubation(T 2);the satisfaction evaluation of patients with anesthesia methods recorded on the first day after operation,the occurrence of cough,nausea and movement during intubation,the complications of tracheal intubation and the satisfaction evaluation of anesthesia methods in the first day after operation.Results:The success rate of tracheal intubation in the observation group was no less than that in the control group,there was no significant difference in the incidence(P>0.05);At T 1 and T 2,HR,MAP and stress response indexes(Cortisol,Noradrenalin,Epinephrine)of the two groups were higher than T 0 and the differences were statistically significant(P<0.05),The HR,MAP and stress response indexes(Cortisol,Noradrenalin,Epinephrine)of the control group were higher than those of the observation group at T 1 and T 2,and the differences were statistically significant(P<0.05).During intubation,the incidence of cough,nausea and movement in the observation group was significantly lower than that in the control group,the difference was statistically significant(P<0.05),and After the first day of follow-up,the incidence of complications of tracheal intubation in the observation group was lower than that in the control group,the difference was statistically significant(P<0.01),the satisfaction of anesthesia in the observation group was significantly higher than that in the control group,the difference was statistically significant(P<0.01).Conclusions:Domestic video intubationscope combined with topical anesthesia through epidural catheter for intubation can achieve a good effect in difficult airway conscious intubation,which can significantly inhibit the stress response of conscious intubation,and greatly improve the satisfaction of patients'comfort,which is worth exploring and promoting.