可视喉镜联合纤维支气管镜在困难气道处理中的价值.docVIP

精品论文 参考文献 可视喉镜联合纤维支气管镜在困难气道处理中的价值 湘潭市第一人民医院麻醉科 湖南湘潭 411101 【摘 要】目的 探讨可视喉镜联合纤维支气管镜（FOB）在已预料困难气道患者气管插管的应用价值。方法 选择择期手术术前麻醉医师访视评估美国麻醉医师协会麻醉分级（ASA）Ⅰ～Ⅱ级的Mallampati气道分级困难气道患者64例，随机数字分类法将其分为可视喉镜组（K组，采用可视喉镜进行困难气管插管）和可视喉镜联合FOB组（L组，采用可视喉镜先置入口腔再使用FOB引导气管内插管），每组32例，两组患者在2%利多卡因10ml经喉麻管注药使舌根部及咽喉腔充分表面麻醉后，使用右美托咪定1ug／㎏（10min）静脉恒速泵注，保留自主呼吸下行气管插管。观察并比较两组患者麻醉诱导前（T0）、镇静10min后（T1）、气管插管即刻（T2）、气管插管后1min（T3）与气管插管后3min（T4）时点血压（BP）、心率（HR）变化，一次气管插管成功率、气管插管用时及术后24小时患者咽喉疼痛、声音嘶哑等并发症。结果 两组气管插管用时L组比K组多，差异有统计学意义（p〈0.05）；气管插管一次成功率L组达100%，K组83%，差异有统计学意义（p〈0.05）；术后24小时咽喉不适L组2例，K组3例，声嘶L组0例，K组1例，T1时点L、K组BP、HR比T0下降，T2、T3、T4时点BP、HR比T0、T1升高，其差异有统计学意义（plt;0.05）。两组BP、HR组间各时点比较差异无统计学意义（pgt;0.05）。结论 可视喉镜及可视喉镜联合纤维支气管镜两种插管方式均适用于困难气管插管处理，可视喉镜联合纤维支气管镜插管时间稍长，但一次插管成功率高，并发症少，更适合一些特殊困难气道插管的处理。 【关键词】可视喉镜 纤维支气管镜 困难气道 清醒插管 表面麻醉 【Abstract】 Objective To investigate the value of video-laryngoscope combined with Fibroptic-bronchoscope（FOB）in predicted difficult airway.。Methods A total of sixty-four cases undergoing selective operation with difficult airway according to Mallampati classification，American Society of Anesthesiologists（ASA）physical status classification I to II were selected. The patients were randomly assigned to video-laryngoscope group（group K，applying video-laryngoscopem to difficult airway）and video-laryngoscope combined FOB group（group L，using FOB after video-laryngoscope was inserted）with 32 cases in each group. Topical anesthesia was performed in all cases with 10ml 2% lidocaine in both throat and root of tongue. Dexmetomidine was used intravenously with 1ug/kg（10min）afterwards. Awake tracheal intubation was then done. We observed blood pressure（BP）and heart rate（HR）before（T0）and 10min after anesthesia induction（T1），the moment（T2），1min（T3）and 3min（T4）after intubation. Also，we recorded one-time success rate，time used for intubation and complications 24h after operation，such as sore throat and hoarseness。Results Group L cost more time than group K. One-time success rate of group L and K was 100% a