不同体位支气管镜检查的麻醉中气道通畅性的随机对照研究

A randomized controlled trial of sitting position and supine position in bronchoscopy on securing a clear airway during anesthesia

摘要:

对坐位及仰卧位支气管镜检查麻醉中气道通畅性进行研究。方法 选取48例行不插管全麻下支气管镜检查的患者随机分为两组。其中24例行坐位下支气管镜检查，24例行仰卧位支气管镜检查，观察两组患者检查过程中气道的通畅性及生命体征变化。结果 坐位支气管镜检查过程中到达隆突的平均时间更短，气道通畅性更好。外周血氧饱和度（SpO2）降低、平均动脉压（MAP）升高和烦躁的发生率明显低于仰卧位。结论 支气管镜检查麻醉可减轻患者不适感与恐惧感，但传统的仰卧位气管镜检查时麻醉可引起舌后坠，咽喉部塌陷、软腭和声带相关的重力可能造成上呼吸道的阻塞，不但给检查带来不便，同时也增加了相应的气道相关性风险及血流动力学不稳定，而坐位支气管镜检查可以通过保证气道通畅性，维持更为稳定的血流动力学状态，使该体位在支气管镜麻醉镇静中的应用更安全，更方便。

Abstract:

To study the airway patency during sitting position and supine position in bronchoscopy during anesthesia. Method Forty-eight patients underwent bronchoscopy during Non-intubation anesthesia were randomly allocated to two groups.There were 24 cases in each group by observeing the airway patency and vital signs of the two groups during the procedure. Result Sitting position in bronchoscopy during anesthesia have the shorter average time to reach the carina, on securing a clear airway. The incidence of desaturation, hypertension and agitation were lower in sitting position during bronchoscopy. Conclusion Bronchoscopy anesthesia can reduce discomfort and fear, but traditional supine bronchoscopy anesthesia can cause displacement of the tongue, collapse of the upper airway in the oropharynx, soft palate and vocal cord related to gravity may seriously obstruct the upper airway, not only brings inconvenience to the inspection, but also increases the risk of airway correlation and hemodynamic instability, Sitting bronchoscopy ensure the airway patency and maintain a more stable hemodynamic state, so that sitting position in the sedation of bronchoscopy anesthesia is safer and more convenient.