作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Effects of Different Manual Airway Maneuvers on Bonfils Intubation Fiberscope-guided Tracheal Intubation
-
摘要:
目的 比较不同辅助手法下Bonfils纤维光导硬镜气管插管的效果。 方法 选择本院经口气管插管全身麻醉下实施择期整形外科手术成年患者90例, 美国麻醉医师协会(American Society of Anesthesiologists, ASA)分级Ⅰ~Ⅱ级, 按不同辅助手法随机分为A组(常规操作, 即头颈伸展位)、B组(单人提下颌)和C组(助手托下颌)。常规麻醉诱导后, 采用Bonfils纤维光导硬镜实施气管插管, 记录气管插管的操作次数、操作时间、血流动力学变化、插管所致气道损伤和术后咽痛等不良反应。 结果 90例患者均一次气管插管成功, A、B和C组的操作时间分别平均为(44.6±38.9)、(33.7±29.4)和(18.9±10.3)s, C组与A、B组比较差异均有统计学意义(P < 0.05);三组患者血流动力学变化相近。A、B和C组术后咽痛或不适分别为12、11和7例; A组上唇损伤1例, 其余2组未发生口咽部组织损伤。 结论 Bonfils纤维光导硬镜在不同辅助手法下行气管插管时, 采用助手托下颌的操作时间最短, 插管损伤最小。 -
关键词:
- Bonfils纤维光导硬镜 /
- 气管插管
Abstract:Objective To compare the effects of different manual airway maneuvers on Bonfils intubation fiberscope-guided tracheal intubation. Methods Totally 90 adult patients with ASA class Ⅰ-Ⅱ who were planning to undergo elective plastic surgery and requiring orotracheal intubation were allocated into three groups:Group A (routine operation), Group B (chin lift), and Group C (external jaw thrust). After intravenous anesthesia induction, all patients were intubated with Bonfils intubation fiberscope. The number of intubation attempts, duration of each intubation attempt, hemodynamic changes, incidence of intubation-related intraoral injury, and postoperative sore throat and other complaints were recorded. Results All patients were successfully intubated at the first attempt. The duration of intubation was significantly short in Group C (18.9±10.3)s than in Group A (44.6±38.9)s and Group B (33.7±29.4)s (P < 0.05). The hemodynamic changes were similar among three groups. The incidence of postoperative sore throat and hoarseness in Group A, B, and C were 12, 11, and 7 patients, respectively. One patient in Group A suffered from injury to the upper lip. Conclusions Bonfils intubating fiberscope is easy to manipulate with high success rate. Both chin lift and external jaw thrust can shorten intubation time, whereas external jaw thrust can help to achieve the shortest intubation time with minimal injury to oral cavity. -
Key words:
- Bonfils intubation fiberscope /
- tracheal intubation
-
表 1 3组患者一般资料和气管插管操作情况(x±s)
组别 性别
(男/女)年龄
(岁)体重
(kg)身高
(cm)操作次数
(1次/2次)操作时间
(s)术后咽痛或不适
(n，%)常规操作组 11 /19 30. 8 ± 10. 5(16 ~ 54) 57. 9 ± 10. 5(43 ~ 80) 165. 4 ± 7. 3(155 ~ 178) 30 /0 44. 6 ± 38. 9(10 ~ 158) 12(40. 0) 单人提下颌组 11 /19 29. 8 ± 10. 5(17 ~ 52) 56. 2 ± 8. 7(45 ~ 83) 165. 0 ± 7. 1(155 ~ 178) 30 /0 33. 7 ± 29. 4(8 ~ 137) * 11(36. 7) 助手托下颌组 13 /17 29. 2 ± 7. 9(16 ~ 41) 56. 0 ± 10. 1(42 ~ 82) 164. 8 ± 5. 9(155 ~ 179) 30 /0 18. 9 ± 10. 3(9 ~ 52) * † 7(23. 3) 与常规操作组比较，* P＜0. 05;与单人提下颌组比较，†P＜0. 05 
下载: 导出CSV
表 2 3组患者收缩压比较(x±s)
组别 诱导前基础值 诱导后即刻 插管后即刻 插管后(min) 1 2 3 4 5 常规操作组 112. 9 ± 12. 1 92. 6 ± 14. 9* 93. 8 ± 11. 0* 109. 7 ± 19. 1 † 102. 7 ± 11. 2* † 99. 3 ± 10. 4* † 95. 1 ± 9. 2* 93. 3 ± 8. 3* 单人提下颌组 111. 8 ± 13. 4* 89. 7 ± 13. 4* 95. 4 ± 18. 0* † 107. 9 ± 23. 3 † 98. 8 ± 14. 5* † 94. 0 ± 13. 2* † 91. 3 ± 11. 5* 89. 0 ± 10. 9* 助手托下颌组 110. 0 ± 13. 5 87. 1 ± 9. 9* 97. 1 ± 14. 3* † 103. 1 ± 12. 8* † 97. 9 ± 12. 3* † 94. 0 ± 11. 6* † 90. 9 ± 9. 7* # 87. 6 ± 9. 5* 与诱导前基础值比较，* P＜0. 05;与诱导后即刻比较，†P＜0. 05
下载: 导出CSV
表 3 3组患者舒张压比较(x±s)
组别 诱导前基础值 诱导后即刻 插管后即刻 插管后(min) 1 2 3 4 5 常规操作组 65. 7 ± 10. 3 48. 0 ± 7. 8* 55. 1 ± 11. 5* † 64. 4 ± 13. 0 † 59. 5 ± 11. 9* † 54. 3 ± 10. 7* † 53. 2 ± 10. 3* † 50. 5 ± 8. 9* 单人提下颌组 67. 5 ± 9. 6 51. 2 ± 8. 2* 57. 6 ± 16. 0* † 66. 2 ± 18. 4 † 58. 6 ± 10. 9* † 55. 9 ± 10. 1* † 52. 6 ± 8. 2* 51. 5 ± 7. 4* 助手托下颌组 65. 8 ± 9. 5 47. 6 ± 7. 8* 59. 9 ± 9. 5* † 60. 0 ± 12. 4* † 54. 7 ± 10. 5* † 51. 4 ± 7. 9* † 48. 2 ± 8. 0* 47. 1 ± 8. 4* 与诱导前基础值比较，* P＜0. 05;与诱导后即刻比较，†P＜0. 05
下载: 导出CSV
表 4 3组患者心率比较(x±s)
组别 诱导前基础值 诱导后即刻 插管后即刻 插管后(min) 1 2 3 4 5 常规操作组 77. 1 ± 14. 5 79. 1 ± 14. 2 80. 9 ± 17. 2 86. 2 ± 16. 3* † 83. 4 ± 14. 8 † 83. 1 ± 14. 8 79. 8 ± 14. 1 78. 8 ± 13. 9 单人提下颌组 76. 6 ± 10. 2 81. 6 ± 11. 3* 83. 7 ± 13. 1 85. 5 ± 18. 5* 83. 5 ± 16. 9 82. 0 ± 14. 7 79. 9 ± 13. 6 78. 5 ± 12. 7 助手托下颌组 76. 8 ± 13. 0 82. 2 ± 13. 2* 85. 2 ± 14. 1* 84. 0 ± 13. 4* 83. 2 ± 14. 1* 82. 1 ± 13. 7* 80. 0 ± 11. 8 78. 3 ± 10. 7 † 与诱导前基础值比较，* P＜0. 05;与诱导后即刻比较，†P＜0. 05
下载: 导出CSV
-
[1] Bein B, Yan M, Tonner PH, et al. Tracheal intubation using the Bonfils intubation fiberscope after failed direct laryngoscopy[J]. Anaesthesia, 2004, 59:1207-1209. doi: 10.1111/j.1365-2044.2004.03967.x [2] Abramson SI, Holmes AA, Hagberg CA. Awake insertion of the Bonfils retromolar intubation FiberscopeTM in five patients with anticipated difficult airways[J]. Anesth Analg, 2008, 106:1215-1217. doi: 10.1213/ane.0b013e318167cc7c [3] Corbanese U, Possamai C. Awake intubation with the Bonfils fibrescope in patients with difficult airway[J]. Eur J Anaesthesiol, 2009, 26:837-841. doi: 10.1097/EJA.0b013e32832c6076 [4] 易杰, 罗爱伦, 黄宇光. Bonfils纤维喉镜用于困难气道病人插管的效果[J].中华麻醉学杂志, 2007, 27:123-125. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhmzxzz98200702008 [5] 隋静湖, 杨冬, 邓晓明, 等. Bonfils纤维光导硬镜用于正常和预测困难气管插管患者的临床评估[J].临床麻醉学杂志, 2007, 23:74-75. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcmzxzz200709026 [6] Stacey MR, Rassam S, Sivasankar R, et al. A comparison of direct laryngoscopy and jaw trust to aid fibreoptic intubation[J]. Anaesthesia, 2005, 60:445-448. doi: 10.1111/j.1365-2044.2004.04119.x [7] Hammer J, Reber A, Trachsel D, et al. Effect of jaw-thrust and continuous positive airway pressure on tidal breathing in deeply sedated infants[J]. J Pediatr, 2001, 138:826-830. doi: 10.1067/mpd.2001.114478 [8] Meier S, Geiduschek J, Reber A, et al. The effect of chin lift, jaw thrust and continuous positive airway pressure on the size of the glottic opening and on stridor in anesthetized, spontaneously breathing children[J]. Anesth Analg, 2002, 94:494-499. doi: 10.1097/00000539-200203000-00004 [9] Reber A, Paganoni R, Frei FJ. Effect of common airway manoeuvres on upper airway dimensions and clinical signs in anaesthetized, spontaneously breathing children[J]. Br J Anaesth, 2001, 86:217-222. doi: 10.1093/bja/86.2.217 [10] Reber A, Wetzel SG, Schnabel K, et al. Effect of combined mouth closure and chin lift on upper airway dimensions during routine magnetic resonance imaging in pediatric patients sedated with propofol[J]. Anesthesiology, 1999, 90:1617-1623. doi: 10.1097/00000542-199906000-00018 [11] Reed WR, Roberts JL, Thach BT. Factors influencing regional patency and configuration of the human infant upper airway[J]. J Appl Physiol, 1985, 58:635-644. doi: 10.1152/jappl.1985.58.2.635 [12] Hirabayashi Y, Hiruta M, Kawakami T, et al. Effects of lightwand (Trachlight) compared with direct laryngoscopy on circulatory responses to tracheal intubation[J]. Br J Anaesth, 1998, 81:253-255. doi: 10.1093/bja/81.2.253 [13] Adachi YU, Takamatsu I, Watanabe K, et al. Evaluation of the cardiovascular responses to fiberoptic orotracheal intubation with television monitoring:comparison with conventional direct laryngoscopy[J]. J Clin Anesth, 2000, 12:503-508. doi: 10.1016/S0952-8180(00)00196-3 [14] Takahashi SJ, Mizutani T, Miyabe M, et al. Hemodynamic responses to tracheal intubation with laryngoscope versus lightwand intubating device (Trachlight) in adults with normal airway[J]. Anesth Analg, 2002, 95:480-484. doi: 10.1213/00000539-200208000-00046 -
点击查看大图
表(4)
计量
- 文章访问数: 110
- HTML全文浏览量: 39
- PDF下载量: 5
- 被引次数: 0
