OSAHS患者手术麻醉中应用纤维喉镜引导经鼻行气管插管

doi:10.6040/j.issn.1673-3770.0.2017.352

摘要/Abstract

摘要： 目的探讨在纤维喉镜引导下经鼻气管插管应用于阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者手术麻醉中的效果。方法选取OSAHS患者70例,将其分为纤维喉镜组和麻醉视频喉镜组,每组35例,观察2个组于纤维喉镜或麻醉视频喉镜引导下经鼻气管插管一次插管成功的例数、插管所用时间以及咽部损伤出血、咽后壁损伤、术中鼻腔活动性出血、术后鼻腔粘连、鼻塞等不良反应发生率。结果纤维喉镜组全部气管导管一次插管成功,平均所用时间(32.34±6.13)s,位置正确,麻醉全程无需调整。麻醉视频喉镜组5例患者有不同原因需要重新插管,均2次成功,平均所用时间(56.54±23.75)s,失败率14%(5/35)。纤维喉镜组插管所用时间明显优于麻醉视频喉镜组(P<0.05)。纤维喉镜组无1例出现鼻腔、咽喉黏膜损伤,术后患者插管侧鼻腔无鼻塞加重症状出现。麻醉视频喉镜组插管后鼻腔活动性出血3例,术后鼻腔粘连3例,咽后壁损伤3例。结论纤维喉镜引导气管插管可作为OSAHS患者困难气管插管首选,方式安全高效。

关键词: 气管插管, 睡眠呼吸暂停, 纤维喉镜, 阻塞性

Abstract: Objective To evaluate the use of nasotracheal intubation guided by fiberoptic laryngoscopy for anesthesia in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods A total of 70 patients with OSAHS, who were scheduled for surgeries under general anesthesia, were equally divided into a nasotracheal intubation group and a video laryngoscope group. Outcomes measured and compared between the two groups included first-attempt intubation success rate, total intubation time, extent of pharyngeal damage and bleeding, extent of posterior pharyngeal wall damage, active bleeding from the nasal cavity during the procedure, postoperative adhesions of the nasal cavity, and rhinobyon. Results In the nasotracheal intubation group, all patients were successfully intubated on the first attempt. The mean total intubation time was 32.34 s±6.13 s, with all positions correct and without requiring anesthesia adjustment. In contrast, in the video laryngoscope group, 5(14%)patients required reintubation; however, all were successfully performed on the second attempt. The mean total intubation time was 56.54 s±23.75 s. The total intubation time was significantly better in the nasotracheal intubation than in the video laryngoscope group(P<0.05). No nasal cavity or pharyngeal mucosal membrane damage occurred postoperatively. In addition, there was no postoperative worsening of nasal obstruction. While intubating patients, 3 had active bleeding. Postoperatively, adhesions of the nasal cavity occurred in 3 patients, while posterior pharyngeal wall damage occurred in 3 patients in the video laryngoscope group. Conclusion Nasotracheal intubation guided by fiberoptic laryngoscopy is a safe and effective option for patients with OSAHS, which may be used as a first-line option.

Key words: Sleep apnea-hypopnea, obstructive, Nasotracheal intubation, Fiberoptic laryngoscopy

中图分类号:

R766.7

张剑伟,倪泽,唐东亮,徐金. OSAHS患者手术麻醉中应用纤维喉镜引导经鼻行气管插管[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 61-64.

ZHANG Jianwei, NI Ze, TANG Dongliang, XU Jin. Nasotracheal intubation guided by fiberoptic laryngoscopy in 35 patients with obstructive sleep apnea hypopnea syndrome undergoing surgeries under general anesthesia[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2018, 32(1): 61-64.

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