视可尼喉镜在引导经鼻气管插管中的临床应用

Clinical Application of Shikani Optical Stylet in Guiding Nasal Tracheal Intubation

目的探讨视可尼喉镜(Shikani optical stylet,SOS)在引导经鼻气管插管中的应用效果。方法回顾性分析我院2017年1月~2022年12月60例经鼻气管插管全身麻醉择期手术的临床资料,按照经鼻气管插管的引导方式分为3组,每组20例:视频喉镜引导气管插管(V组),纤维支气管镜引导气管插管(F组)和SOS引导气管插管(S组)。比较3组患者气管插管过程中喉部显露分级、鼻出血情况、气管插管成功率、完成时间和术后气管插管并发症的发生情况。结果F、S组患者喉显露分级均为Ⅰ级,V组患者喉显露分级Ⅰ级7例、Ⅱ级10例、Ⅲ级3例,F、S组患者喉显露效果明显优于V组(Z=-4.274,P=0.000;Z=-4.274,P=0.000)。F、S组患者无鼻出血分别为15、14例,轻度分别为5、6例,均无患者发生重度鼻出血,V组患者无鼻出血7例,轻度10例,重度3例,F、S组患者鼻出血的程度明显轻于V组(Z=-2.678,P=0.007;Z=-2.402,P=0.016)。S组患者气管插管完成中位时间37.5(34.3,41.5)s,显著短于V组45.0(39.8,72.5)s和F组89.0(76.0,102.5)s(Z=15.703,P=0.013;Z=32.050,P=0.000),V组明显短于F组(Z=-16.347,P=0.009)。V组2例插管失败,F和S组患者均顺利完成气管插管,3组插管成功率差异无统计学意义(P>0.05)。3组患者术后鼻咽部疼痛、鼻塞发生率差异无统计学意义(P>0.05)。结论SOS引导经鼻气管插管可以提供良好的喉显露,气管插管成功率满意且不增加不良反应发生率,可视为一种安全而有效的经鼻气管插管方式。

Objective To explore the clinical application of the Shikani optical style(SOS)in guiding nasal tracheal intubation.Methods A retrospective analysis was made on clinical data of 60 patients who underwent selective operation under general anesthesia through nasal tracheal intubation from January 2017 to December 2022.According to the guidance methods of nasal tracheal intubation,the patients were divided into three groups with 20 cases in each group:video laryngoscope guided nasal tracheal intubation group(group V),fiberoptic bronchoscopy guided nasal tracheal intubation group(group F),and SOS guided nasal tracheal intubation group(group S).The grading of glottis exposure and epistaxis during tracheal intubation were recorded,as well as the success rate,completion time,and incidence of postoperative complications related to nasal tracheal intubation.Results The glottis exposure in the group F and group S were both gradeⅠ.Among the group V,there were 7 cases of gradeⅠ,10 cases of gradeⅡ,and 3 cases of gradeⅢ.The glottis exposure effect of patients in the group F and S was significantly better than that of the group V(Z=-4.274,P=0.000;Z=-4.274,P=0.000).There were 15 and 14 patients in the group F and the group S without epistaxis,and 5 and 6 patients with mild epistaxis,respectively.There were no patients with severe epistaxis in the group F and the group S.In the group V,there were 7 patients without epistaxis,10 patients with mild epistaxis,and 3 patients with severe epistaxis.The degree of epistaxis in the group F and the group S was significantly less than that in the group V(Z=-2.678,P=0.007;Z=-2.402,P=0.016).The median time for tracheal intubation in the group S was 37.5(34.3,41.5)s,significantly shorter than 45.0(39.8,72.5)s in the group V and 89.0(76.0,102.5)s in the group F(Z=15.703,P=0.013;Z=32.050,P=0.000),with the group V being significantly shorter than the group F(Z=-16.347,P=0.009).The nasal tracheal intubation failed in 2 cases in the group V,while was all successfully completed in the group F and the group S.The difference of success rate was not statistically significant among the three groups(P>0.05).There were no statistically significant differences in the rates of postoperative nasopharyngeal pain and nasal congestion among the three groups(P>0.05).Conclusion The method of SOS-guided nasal tracheal intubation can provide good glottis exposure and achieve a satisfactory success rate of tracheal intubation without increasing the risk of adverse reactions,which can be regarded as a safe and effective method of nasal tracheal intubation.