不同折弯角度可视管芯引导经鼻气管插管效果的比较

Comparison of the effect of different bending angles for nasotracheal intubation with video stylet

目的观察不同折弯角度可视管芯引导经鼻气管插管的效果。方法选择择期行颌面手术经鼻气管插管的全麻患者120例,男19例,女101例,年龄18~60岁,ASAⅠ或Ⅱ级。根据插管时可视管芯前端折弯角度的不同,将患者随机分为三组:70°组、90°组和110°组。记录鼻孔-喉结的垂直距离(简称TND)、插管时间、插管次数、声门显露情况、插管辅助手法以及鼻出血情况。结果三组TND差异无统计学意义。90°组、110°组插管时间明显短于70°组,插管成功率明显高于70°组(P<0.05)。90°组、110°组插管时间、插管成功率差异无统计学意义。90°组声门显露级别明显优于70°组和110°组(P<0.05),70°组、110°组声门显露级别差异无统计学意义。三组插管时均采用头后仰的辅助手法,但70°组后仰程度大,而90°组、110°组多为轻度后仰。110°组有1例(2.5%)需辅助提颏,1例(2.5%)需助手辅助托下颌,而70°组则有6例(15.0%)需调整喉部位置。三组鼻出血发生率差异无统计学意义。结论可视管芯引导经鼻气管插管时,与70°折弯角度比较,90°折弯角度插管时间更短、成功率更高、插管所需辅助调整更少。110°折弯角度插管时间和成功率和90°折弯角度接近,但需要更多的辅助调整。

Objective To observe the optimal bending angle of stylet for nasotracheal intubation.Methods A total of 120 patients scheduled for selective maxillofacial surgery under general anesthesia requiring nasotracheal intubation,19 males and 101 females,aged 18-60 years,ASA physical statusⅠorⅡ,were enrolled in the study.Patients were assigned into one of three groups according to the bending angle of the stylet:70°group,90°group,and 110°group.Nostril-thyroid prominence distance,intubation time,success rates of intubation,glottic view grading,additional maneuvers and epistaxis were recorded.Results There was no statistically significant difference in nostril-thyroid prominence distance between the three groups.Intubation time in 90°group was similar to that in 110°group,but was shorter than that in 70°group(P<0.05).Success rates were comparable between the 90°group and 110°group,both of which was higher than that in the 70°group.There was no statistically significant difference in intubation time and intubation success rate between 90°group and 110°group.The glottic view grading was better in 90°group than that in 70°group and 110°group(P<0.05).There was no statistically significant difference in the level of glottal exposure between the 70°group and the 110°group.The three groups of intubation all adopted the auxiliary technique of head reclining,but the 70°group had a large degree of head back,while the 90°group and the 110°group mostly had a slight head back.In the 110°group,1 patient(2.5%)required assisted chin lift,1 patient(2.5%)required an assistant to support the mandible,while 6 patients(15.0%)in the 70°group required adjustment of the larynx position.There was no statistically significant difference in the incidence of epistaxis among the three groups.Conclusion For the nasotracheal intubation with video stylet,a 90°bending angle can achieve a shorter intubation time,a higher success rates and less additional maneuvers compared to a 70°bending angle.Intubation time and success rates are similar between 110°and 90°bending angle,but more additional maneuvers are required for the 110°bending angle.