国产明视插管软镜与纤维支气管镜经鼻困难气管插管的比较*

Comparison of domestic video intubationscope versus fiberoptic bronchoscope for difficult nasotracheal intubation*

摘要:

比较国产明视插管软镜（VIS）与纤维支气管镜（FOB）引导经鼻困难气管插管的临床应用效果。方法 择期选择困难气道患者60例，Mallampati评分为Ⅲ或Ⅳ级，美国麻醉师协会评级（ASA）Ⅰ或Ⅱ级，年龄22～68岁，体重53～82 kg，随机分为VIS组（V组）和FOB组（F组），每组30例。分别采用VIS和FOB引导经鼻气管插管。观察记录两组气管插管时间、气管插管成功率及气管插管相关并发症发生情况，记录麻醉诱导前（T0）、麻醉诱导后（T1）、声门暴露时（T2）、气管导管进入声门即刻（T3）的平均动脉压（MAP）、心率（HR）和脉搏血氧饱和度（SpO2）。结果 与T0时比较，T1时两组MAP明显下降、HR明显减慢（均P <0.05）；与T1时比较，T3时两组MAP明显升高、HR明显增快（均P <0.05），两组间比较差异无统计学意义（P >0.05）；气管插管期间两组SpO2均无明显降低。V组和F组气管插管时间分别为（76.0±18.0）和（80.0±20.0）s、一次气管插管成功率分别为96.7%和93.3%，两组间比较差异均无统计学意义（均P >0.05）；气管插管并发症发生率两组间比较差异无统计学意义（P >0.05）。结论 与FOB相比较，国产VIS引导经鼻困难气管插管同样安全可靠、快速有效、插管成功率高，气管插管并发症少。

Abstract:

Abstract: Objective To compare the clinical effects of domestic video intubationscope (VIS) versus fiberoptic bronchoscope (FOB) for difficult nasotracheal intubation. Methods 60 ASA I or II elective patients with difficult airway, Mallampati class III or IV, aged 22 ~ 68 years, weight 53 ~ 82 kg, were randomly divided into domestic video intubationscope group (group V) and fiber bronchoscope group (group F), 30 cases in each group. The nasotracheal intubation was respectively guided by VIS in group V and FOB in group F. Tracheal intubation time, success rate of tracheal intubation and complications of tracheal intubation were recorded. MAP, HR and SpO2 were recorded at before anesthesia induction (T0), after anesthesia induction (T1), at glottic exposure (T2), at intubation (T3). Results  Compared with T0, MAP and HR were significantly decreased in both groups at T1 (P < 0.05). MAP and HR were significantly increased in both groups at T3 than those at T1 (P < 0.05), and there were no significant differences between the two groups (P > 0.05). SpO2 during tracheal intubation was no significantly reduced in both groups. The tracheal intubation time were respectively (76.0 ± 18.0) s and (80.0 ± 20.0) s in group V and group F, and the one-time success rate of intubation in group V and group F were respectively 96.7% and 93.3%, but there were no significant differences between the two groups (P > 0.05). there was no significant difference in the incidence of tracheal intubation complications between the two groups (P > 0.05). Conclusions Compared with FOB, difficult nasotracheal intubation guided by domestic VIS also is a safe and reliable, fast and effective method with high intubation success rate and less complications of tracheal intubation.