Hc可视喉镜与Macintosh喉镜应用于模拟困难气道的临床研究
发布时间：2018-12-06 17:42
【摘要】：目的： 为临床困难气道处理的培训提供有效工具,本研究使用充气型颈托固定器评价使普通气道变成困难气道的可行性及效果；以及观察Hc可视喉镜应用于模拟困难气道患者气管插管时的有效性和安全性. 方法： 1.预试验,自愿的原则下,征集女性自愿者100名,记录年龄,体重指数(BMI),使用改进充气型颈托固定器测量在其无不适感下最大充气量,并计算压力值均数。 2.选择2012年5月-2013年1月需全麻气管插管接受妇科腹腔镜的病人60例,年龄18-60岁,体重指数18～26kg/m2,ASA分级Ⅰ～Ⅱ级,术前得到患者同意并签知情同意书,术前一天术前访视时进行气道评估,记录张口度。均采用静吸复合全身麻醉。 病人有面罩通气困难或可预见的困难气管插管者均排除,另外有困难气管插管史者也排除。随机分为2组：H组(Hc可视喉镜组)和M组(Macintosh喉镜组)(n=30)。均采用静吸复合全身麻醉,患者进入手术室后连接监护仪,平卧休息后,静吸复合全麻使用颈托固定器,以此前预试验压力值充气,模拟困难气道,测量此时张口度。 3.喉镜气管插管 两组分别使用Hc可视喉镜和Macintosh喉镜进行气管插管,并同时采取Cormack-Lehane标准进行喉部暴露情况评级,每例病人在保证通气和良好的脉搏氧饱和度下最多被允许插管两次,或者当麻醉医生认为再试插一次对病人会有危险时,则要去除颈托固定器,使用直接喉镜进行气管插管。记录插管成功时间及试插管次数。记录气管插管前,最佳显露声门时,气管导管插入即刻,气管导管插入后1min,2min,3min的MAP,HR及术后咽喉部疼痛不适及创伤 结果： 1.使用充气型颈托固定器模拟困难气道患者患者张口度变小有统计学意义(P0.05) 2.模拟困难气道患者声门暴露分级(Cormack-Lehane标准),与Macintosh喉镜相比,Hc可视喉镜可以降低声门分级级别,Hc可视喉镜能提供更好的声门暴露情况 3.H组插管成功率高于M组,插管时间两组间无显著差异。 4.最佳显露声门时,气管导管插入即刻,气管导管插入后lmin血流动力学波动,H组波动小于M组,有统计学意义(p0.05) 5.M组有11例(36.7%)患者出现拔管后咽喉痛,H组的3例(10%),有统计学意义p0.05并M组有4例(13.3%)气管导管带血,发生率明显高于H组的0例(p0.05),疼痛与咽部粘膜出血于术后第2天缓解及康复。两组患者均无其他重大不良事件发生。 结论： 应用充气型颈托固定器模拟困难气道是安全有效的；与Macintosh喉镜相比,Hc可视喉镜应用于模拟困难气道,可以降低声门暴露(Cormack-Lehane标准)分级并改善视野,插管成功率高,对血流动力学影响小,咽喉部并发症少。
[Abstract]:Objective: to provide an effective tool for the training of clinical difficult airway management. The purpose of this study was to evaluate the feasibility and effect of making the common airway into a difficult airway by using an inflatable cervical fixator. To observe the efficacy and safety of Hc visual laryngoscope in tracheal intubation in simulated difficult airway patients. Methods: 1. On a voluntary basis, 100 female volunteers were recruited to record their age and body mass index (BMI), using an improved inflatable cervical fixator to measure the maximum volume of inflation without discomfort, and to calculate the mean value of pressure. 2. From May 2012 to January 2013, 60 patients, aged 18-60 years, who needed general anesthesia and endotracheal intubation to undergo gynecologic laparoscopy were selected. The body mass index (BMI) was 18 ~ 26kg / m ~ (2) ASA grade 鈪，
本文编号：2366409
[Abstract]:Objective: to provide an effective tool for the training of clinical difficult airway management. The purpose of this study was to evaluate the feasibility and effect of making the common airway into a difficult airway by using an inflatable cervical fixator. To observe the efficacy and safety of Hc visual laryngoscope in tracheal intubation in simulated difficult airway patients. Methods: 1. On a voluntary basis, 100 female volunteers were recruited to record their age and body mass index (BMI), using an improved inflatable cervical fixator to measure the maximum volume of inflation without discomfort, and to calculate the mean value of pressure. 2. From May 2012 to January 2013, 60 patients, aged 18-60 years, who needed general anesthesia and endotracheal intubation to undergo gynecologic laparoscopy were selected. The body mass index (BMI) was 18 ~ 26kg / m ~ (2) ASA grade 鈪，
本文编号：2366409
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