HC视频喉镜联合纤维支气管镜在颈椎制动患者气管插管中的应用

Application of HC video laryngoscope combined with fiberoptic bronchoscopy in tracheal intubation in patients with cervical spine immobilization

摘要:

目的??探讨HC视频喉镜联合纤维支气管镜在颈椎制动患者气管插管中应用。方法?选择颈椎制动拟全麻手术患者80例随机分为纤维支气管镜组（F组），HC视频喉镜复合纤维支气管镜经鼻插管组（H组），每组40例。充分局部麻醉及静脉麻醉后，保留自主呼吸，行气管插管。记录诱导前（T0）、气管插管前即刻（T1）、气管插管后即刻（T2）、气管插管后1 min（T3）平均动脉压（MAP）、心率（HR）变化，记录首次插管成功率、插管时间。记录气管插管操作相关并发症发生率。结果?两组患者气管插管前即刻（T1）MAP和HR差异无统计学意义（t =0.75、-0.51，P =0.453、P =0.611）；两组插管后即刻（T2）MAP和HR较气管插管前即刻（T1）MAP（t =5.08、4.36，P =0.021、P =0.013）和HR（t =7.22、6.54，P =0.026、P =0.031）差异均有统计学意义（P <0.05），血流动力学均维持在正常范围，两组间比较MAP和HR差异均无统计学意义（t =-0.51、-0.31，P =0.411、P =0.518）；插管后1 min（T3）两组间比较MAP和HR差异均无统计学意义（t =0.38、0.26，P =0.681、P =0.372）。H组患者首次气管插管成功率明显高于F组，差异有统计学意义（χ2=7.31，P =0.007）。两组气管插管时间H组明显少于F组，差异有统计学意义（t =5.75，P =0.000）。F组患者术后咽痛发生率明显高于H组，差异有统计学意义（χ2=5.00，P =0.025）。结论?颈椎制动患者经鼻气管插管中，HC可视喉镜联合纤维支气管镜，较传统纤维支气管镜插管，首次插管成功率更高，插管时间更短，不加重血流动力学波动，咽痛发生率更低。

Abstract:

Objective?To explore the application of HC video laryngoscope combined with fiberoptic bronchoscopy in tracheal intubation in patients with cervical spine immobilization.?Methods?80 cases of cervical spine immobilization to surgery patients under general anesthesia were randomly divided into bronchoscopy group (F group), HC video laryngoscope composite fiber bronchoscope nasotracheal intubation group (H group), 40 cases in each group. Full of local anesthesia and intravenous anesthesia, spontaneous breathing, tracheal intubation. Recorded before induction (T0), immediately before intubation (T1), immediately after intubation (T2), 1 minutes after tracheal intubation (T3) mean arterial pressure (MAP), heart rate (HR) changes, record for the first time intubation success rate, intubation time of patients. The incidence of complications related to intubation operation.?Results?there were no significant differences between the two groups before and after tracheal intubation (T1) MAP and HR (t = 0.75, -0.51, P = 0.453, 0.611); After the two groups were intubated immediately (T2), MAP and HR than immediately before intubation (T1), the differences were statistically significant MAP (t = 5.08, 4.36, P = 0.021, 0.013) and HR (t = 7.22, 6.54, P = 0.026, 0.031), hemodynamics were maintained in the normal range, after intubation immediately (T2) between the two groups compared differences in MAP and HR had no statistical significance (t = -0.51, -0.31, P = 0.411, 0.518); There was no significant difference in HR and MAP between the two groups (t = 0.38, 0.26, P = 0.681, 0.372) in 1 min after intubation (T3). Patients with tracheal intubation success rate for the first time H group was obviously higher than that of group F, the difference was statistically significant (χ2 = 7.31, P = 0.007). The two group intubation time in H group was significantly less than that in F group, the difference was statistically significant (t = 5.75, P = 0.000). The incidence of sore throat in group F was significantly higher than H group, the difference was statistically significant (χ2 = 5.00, P = 0.025).?Conclusions?The patients with cervical spine immobilization of nasotracheal intubation, HC video laryngoscope combined with fiberoptic bronchoscopy, compared with the traditional fiberoptic intubation, intubation for the first time a higher success rate, shorter intubation time, no aggravation of hemodynamic fluctuations, lower incidence of sore throats.