左侧俯卧位可视化气管插管技术在老年患者ERCP术中的应用

Application of Visualization Tracheal Intubation Technique in Left Prone Position in Elderly Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

目的 探讨老年患者左侧俯卧位下气管插管行内镜逆行胰胆管造影术(ERCP)的可行性和安全性。方法 选取河南省人民医院2020年8月至2021年3月接受内镜ERCP治疗的50例老年胆管结石患者,按照随机数字表法分为对照组和试验组,各25例。麻醉诱导后试验组在左侧俯卧位下置入气管导管,对照组在仰卧位下置入气管导管,行机械通气。记录两组患者平均动脉压(MAP)、指脉氧饱和度(SpO_(2))、心率(HR)、Mallampati分级、摆体位时间、插管成功时间、反流误吸、插管次数和插管损伤发生情况等。结果 两组性别、年龄、美国麻醉医师协会(ASA)分级、手术时间、体重及Mallampati分级比较,差异无统计学意义(P>0.05)。试验组T_(1)的MAP、HR高于对照组,MAP较稳定(P<0.05)。试验组摆体位时间短于对照组(P<0.05),两组插管时间、插管次数、插管损伤比较,差异无统计学意义(P>0.05)。两组均未出现误吸。结论 气管插下ERCP术老年患者取左侧俯卧位可降低循环波动,缩短摆体位时间。

Objective Explore the feasibility and safety of endoscopic retrograde cholangiopancreatography(ERCP)with tracheal intubation in the left prone position in elderly patients.Methods Fifty elderly patients with bile duct stones who underwent endoscopic ERCP treatment in Henan Provincial People’s Hospital from August 2020 to March 2021 were selected and randomly divided into control group and experimental group,with 25 patients in each group.After anesthesia induction,the experimental group placed a tracheal catheter in the left prone position,while the control group placed a tracheal catheter in the supine position and underwent mechanical ventilation.The mean artery pressure(MAP),pulse oxygen saturation(SpO_(2))and heart rate(HR),Mallampati grading,positioning time,successful intubation time,reflux aspiration,intubation frequency,and occurrence of intubation injury in two groups of patients were recorded.Results There was no statistical differences in sex,age,American Anesthesiologist Association(ASA)classification,operation time,body mass and Mallampati classification between the two groups(P>0.05).The MAP and HR of T_(1) in the experimental group were higher than those in the control group,and the MAP was relatively stable(P<0.05).The positioning time of the experimental group was shorter than that of the control group(P<0.05),and there was no statistical differences in intubation time,intubation frequency,and intubation injury between the two groups(P>0.05).Both groups did not experience aspiration.Conclusion Taking the left prone position for elderly patients undergoing tracheal intubation ERCP can reduce circulatory fluctuations and shorten the positioning time.