胃镜协助气管插管在无痛内镜手术中的应用

Clinical application of gastroscope to guide endotracheal intubation for painless gastroscopic treatment

摘要:

目的 研究胃镜协助气管插管在无痛内镜手术全身麻醉气管插管中的临床应用效果和优势。方法 选取2018年1月－2019年12月该院收治的80例拟行内镜手术的全身麻醉气管插管患者，随机分成普通喉镜组（n = 40）和胃镜协助组（n = 40），普通喉镜组直接行气管插管，胃镜协助组采用胃镜协助的气管插管法。记录两组患者一次性插管成功率、气管插管时间、心血管事件及不良反应发生情况。结果 胃镜协助组一次插管成功率明显高于普通喉镜组（97.50%和85.00%，P = 0.048），气管插管时间明显短于普通喉镜组［（32.31±6.05）和（50.47±10.47） s，P = 0.000］。与普通喉镜组相比，胃镜协助组的心血管事件发生率［平均动脉压（MAP）增高（2.6%和14.7%，P = 0.029）、心动过速（5.1%和38.2%，P = 0.000）］、并发症总发生率（5.1%和23.5%，P = 0.023）较低；呛咳发生率为5.1%，术后未出现口咽部黏膜出血、门齿松动及声音嘶哑等并发症，两组比较，差异无统计学意义（P = 0.303、P = 0.125、P = 0.281、P = 0.281）。结论 胃镜辅助气管插管在全身麻醉中应用效果良好，插管成功率较普通喉镜高，无需变换体位，且总体不良反应少，但需内镜人员协助完成，更适合在内镜中心推广。

Abstract:

Objective To evaluate the clinical application and advantages of gastroscope-assisted intubation during intravenous anesthesia.Methods 80 patients who received for endotracheal intubation during painless gastroscopic treatment from January 2018 to December 2019 were divide into the conventional laryngoscope group (n = 40) and the gastroscope-assisted intubation group (n = 40). The success rate of the first time intubation, the tracheal intubation time, haemodynamic events and the complications related intubation in the two groups were recorded.Results The success rate of the first time intubation was significantly higher in gastroscope-assisted intubation group than that in the conventional laryngoscope group (97.50% vs 85.00% P = 0.048). The tracheal intubation time of the gastroscope-assisted intubation group were shorter than that of the conventional laryngoscope group [(32.31 ± 6.05) s vs (50.47 ± 10.47) s, P = 0.000]. Compared with conventional laryngoscope group, the gastroscope-assisted intubation groups with a low incidence of haemodynamic events [High mean arterial pressure (2.6% vs 14.7% P = 0.029), Heartbeat tachycardia (5.1% vs 38.2%, P = 0.000)] and total complication (5.1% vs 23.5%, P = 0.023). The coughs (5.1%) was observed in gastroscope-assisted intubation group, no bleeding symptom of oral mucosa, tooth mobility and hoarse voice were observed, while had no statistical difference compared to conventional laryngoscope group (P = 0.303, P = 0.125, P = 0.281, P = 0.281).Conclusion The application of alternate can improve the success rate of intubation, reduce the time of catheterization, need not postural change and obviously reduce the complications during the operation. Due to the procedures of intubation was assistance by endoscopists, deserving the clinical expansion in digestive endoscopy centers.