硬质喉镜引导经鼻气管插管在不稳定型颈椎骨折患者中的应用

Application of rigid laryngoscope guided nasotracheal intubation in patients with unstable cervical spine fracture

目的探讨硬质喉镜引导经鼻气管插管在不稳定型颈椎骨折患者中应用的可行性。方法选择我院收治的不稳定型颈椎骨折患者60例,拟择期行颈椎后路减压内固定术。采用随机表法将所有患者随机分为两组:硬质喉镜引导经鼻气管插管组(观察组)和普通喉镜+插管钳引导经鼻气管插管组(对照组),每组各30例。两组患者麻醉诱导前3 min,均采用麻黄碱收缩鼻黏膜,充分润滑气管导管前1/3。常规麻醉诱导后,观察组采用硬质喉镜引导经鼻气管插管;对照组采用普通喉镜暴露声门,插管钳辅助下引导经鼻气管插管。观察两组患者一次插管成功率,插管时间,插管前后HR、平均动脉压(MBP)变化情况,术后咽喉部疼痛发生率。结果观察组一次插管成功率(100%)高于对照组(83%),两组对比差异有统计学意义(P<0.05);观察组插管完成时间(35.2±4.5)s,短于对照组的(47.7±4.2)s,两组对比差异有统计学意义(P<0.05);两组患者插管后HR、MBP对比,观察组HR、MBP均低于对照组,两组对比差异均有统计学意义(P<0.05);术后咽喉部疼痛发生率对比,观察组(10.0%)低于对照组(33.3%),两组对比差异有统计学意义(P<0.05)。结论将硬质喉镜引导经鼻气管插管应用于不稳定型颈椎骨折患者,具有一次插管成功率高,插管完成时间短,插管应激反应小,术后咽喉部疼痛发生率低等优点。

Objective To investigate the feasibility of rigid laryngoscope guided nasotracheal intubation in patients with unstable cervical spine fracture.Methods Sixty patients with unstable cervical spine fracture admitted to our hospital were selected to undergo posterior cervical decompression and internal fixation.All the patients were randomly divided into two groups:rigid laryngoscope guided nasotracheal intubation group(observation group)and ordinary laryngoscope combined with tube forceps guided nasotracheal intubation group(control group),with 30 cases in each group.Three minutes before induction of anesthesia,ephedrine was used to contract the nasal mucosa and fully lubricate the first 1/3 of the tracheal tube in both groups.After conventional induction of anesthesia,the observation group received rigid laryngoscope guided nasotracheal intubation.In the control group,ordinary laryngoscope was used to expose the glottis,and nasotracheal intubation was guided with the assistance of intubating forceps.The success rate of one intubation,the time of intubation,the changes of HR,mean blood pressure(MBP)before and after intubation,and the incidence of postoperative laryngopharyngeal pain in the two groups were observed.Results The success rate of the first intubation in the observation group(100%)was higher than that in the control group(83%),and the difference between the two groups was statistically significant(P<0.05).The completion time of intubation in the observation group[(35.2±4.5)s]was shorter than that in the control group[(47.7±4.2)s],and the difference between the two groups was statistically significant(P<0.05).After intubation,HR and MBP in the two groups were compared,and HR in the observation group was lower than that in the control group,while MBP in the control group was higher than that in the observation group.The difference between both groups was statistically significant(P<0.05).The incidence of postoperative throat pain in the observation group(10.0%)was lower than that in the control group(33.3%),and the difference between the two groups was statistically significant(P<0.05).Conclusion The application of rigid laryngoscope guided nasotracheal intubation in patients with unstable cervical spine fracture has the advantages of high success rate of intubation at one time,short completion time of intubation,little stress of intubation,and low incidence of postoperative throat pain.