摘要
目的分析两步气管插管法用于全麻下气管插管的安全性和可行性。方法选择择期行全麻下气管插管患者60例,随机分为两步法气管插管组和传统气管插管组,每组30例。两步气管插管法即先把喉镜片置入患者口腔内并顺势深入到舌根部位再连接上喉镜柄进行气管插管。比较两组患者全麻诱导后一次插管成功率、插管时间、插管时患者的张口距离、后仰头部的发生率、转动头部的发生率、打开颞颌关节的发生率、喉镜片拨动舌头的发生率、插管过程中肉眼可见医源性损伤发生率以及插管前后血压、心率、无创血氧饱和度的情况。结果两步法气管插管组在全麻插管过程中置入喉镜片时患者的张口距离和喉镜片拨动舌头的发生率均小于传统气管插管组(t=23.45,χ^(2)=7.07,P均<0.05)。两步法气管插管组在全麻插管时后仰头部、转动头部和打开颞颌关节的发生率均小于传统气管插管组(χ^(2)分别=4.63、5.82、4.63,P均<0.05)。两组患者插管时间、插管前后的平均血压(MBP)、心率(HR)、无创血压饱和度(SPO_(2))和插管过程中肉眼可见口腔损伤(包括口腔软组织损伤、出血,舌体损伤、出血,牙齿损伤、松动、脱落等)发生率比较,差异均无统计学意义(t分别=0.78、1.25、0.25、0.25、0.94、0.45、0.99,χ^(2)=1.40,P均>0.05)。结论两步气管插管法避免了喉镜柄与患者胸部的抵触,有更好的操作性。相比于传统气管插管法,两步气管插管法插管角度限制更小,可以在尽量不改变患者头面颈部位置前提下实施插管,有较高的安全性和可行性。
Objective To analyze the safety and feasibility of two-step endotracheal intubation.Methods Sixty patients were randomly divided into two-step tracheal intubation group and traditional tracheal intubation group,thirty cases in each.Two-step tracheal intubation was the way that the laryngoscope blade was inserted into the oral cavity of the patient and went down to the tongue base before connecting with the laryngoscope handle.The success rate of intubation,the time of intubation,the distance of mouth opening,the incidence of backward head tilting,side turning of head,forcedly opening temporomandibular joint,laryngoscope pushing aside tongue,and the blood pressure,heart rate and oxygen saturation change before and after intubation were compared between the two groups.Results The distance of mouth opening and incidence of pushing aside tongue in patients with laryngoscope during intubation in two-step tracheal intubation group were significantly lower than those in traditional tracheal intubation group(t=23.45,χ^(2)=7.07,P<0.05).The incidence of backward head tilting,side turning of head and forcefully opening temporomandibular joint during intubation in two-step tracheal intubation group were significantly lesser than those in traditional tracheal intubation group(χ^(2)=4.63,5.82,4.63,P<0.05).There were no significant differences in the time of intubation,mean blood pressure,heart rate,oxygen saturation change before and after intubation,and the incidence of oral injury(including oral soft tissue injury,tongue injury,bleeding,tooth injury,tooth loosening,tooth loss,etc.)during intubation(t=0.78,1.25,0.25,0.25,0.94,0.45,0.99,χ^(2)=1.40,P>0.05).Conclusion Two-step tracheal intubation avoided collision of the laryngoscope handle to the chest of patient,and has better operability.Compared with traditional tracheal intubation,two-step tracheal intubation can be performed with minimal change in the patient’s head,face and neck position with more safety and feasibility.
作者
吴振威
倪华栋
姚益冰
来岚
陆雅萍
周煦燕
姚明
WU Zhenwei;NI Huadong;YAO Yibing(Department of Anesthesiology,The First Hospital of Jiaxing,Jiaxing 314000,China)
出处
《全科医学临床与教育》
2021年第11期989-992,F0002,共5页
Clinical Education of General Practice
基金
嘉兴市公益性研究计划(2020AD30051)
浙江省省市共建疼痛医学重点学科(2019-ss-ttyx)。
关键词
两步气管插管
医源性损伤
困难气道
短柄喉镜
困难插管
two-stop tracheal intubation
iatrogenic injury
difficult airway
short shank laryngoscope
