摘要
目的观察帝视内窥镜引导清醒状态下气管插管和纤维支气管镜气管插管在困难气道患者中的应用及其对机体应激和不良反应的影响。方法选取2013年1月～2014年4月于上海市奉贤区中心医院．麻醉前评估为困难气道全麻手术患者90例，随机分为观察组和对照组，每组各45例。观察组予以帝视内窥镜引导气管插管，对照组予纤维支气管镜的气管插管。观察麻醉诱导前（T0）、诱导后（T1）和插管成功3min（T3）各个时点的平均动脉血液（MAP），心率一收缩压乘积（RPP），皮质醇、促肾上腺皮质激素（ACTH）水平，内皮素（ET）水平和不良反应情况。结果观察组的一次插管成功率（82．22％）与对照组（77．78％）比较，差异无统计学意义（P〉0．05）。观察组的插管时间[（39．26±7．38）s1明显低于对照组[（51．87±9．42）s]，差异有高度统计学意义（P〈0．01），观察组的不良反应发生率（4．44％）明显低于对照组（22．22％），差异有统计学意义（P〈0．05）。两组的T1时间点的HR、MAP、RPP、皮质醇、ACTH和ET水平明显低于T0时点，差异有高度统计学意义（P〈0．01）；两组的T2时点的HR、MAP、RPP、皮质醇、ACTH和ET水平明显高于T1时间点，差异有高度统计学意义（P〈0．01）；而两组相同时点比较，差异无统计学意义（P〉0．05）。结论对于困难气道患者，虽然纤维支气管镜为公认的首选办法，但帝视内窥镜气管插管同样具有较高的插管成功率，对机体的血流动力学影响小和应激反应少等特点，同时具有插管时间短和不良反应少等优势．值得临床推广。
Objective To observe the application of awake tracheal intubation guided by disposcope and bronchofibro- scope in patients with difficult airways and their impact of the stress response and adverse effects. Methods From January 2013 to April 2014, in the Center Hospital of Fengxian District in Shanghai City, 90 patients with difficult airways from pre-anaesthetic assessment were randomly divided into observation group and control group, with 45 cases in each group. The observation group were given the tracheal intubation guided by disposcope, the control group were given the tracheal intubation guided by bronchofibroscope. The mean arterial blood （MAP）, heart rate-systolic blood pressure product （RPP）, cortisol, adrenocorticotropic hormone （ACTH）, endothelial （ET） at anesthesia before induction （T0）, anesthesia after induction （T1）, success 3 min after intubation （T3） and adverse reactions of two groups were observe. Results The success rate of intubation in observation group （77.78%） and control group （82.22%） was compared, the difference was not statistically significant （P 〉 0.05）. The intubation time [（39.26±7.38） s] in observation group was significantly lower than that in the control group [（51.87±9.42）s], the difference was statistically significant （P 〈 0.01）. Incidence of adverse reactions in observation group （4.44%） was significantly lower than that in control group （22.22%）, the difference was statistically significant （P 〈 0.05）. The levels of HR, MAP, RPP, cortisol, ACTH and ET in each group at T1 point were lower than those at To point, and these levels at T2 point were significantly higher than those at T1 point, the differences were statistically significant （P 〈 0.01）, these levels at the same time point in two groups were compared, the differences were not statistically significant （P 〉 0.05）. Conclusion The tracheal intubation guided by bronchofibroscope is recognized as the preferred approach in patients with difficult airways, but disposcope also has a high success rate, a less small hemodynamic effects on the body,less stress response, but also less intubation time and fewer adverse reactions and so on, it is worthy to be recommended in clinic.
出处
《中国医药导报》
CAS
2015年第16期137-140,共4页
China Medical Herald
关键词
气管插管
应激
帝视内窥镜
纤维支气管镜
Intubation
Stress
Disposcope
Blood theology
Bronchofibroscope
