Clarus可视管芯引导气管插管的临床研究

发布时间：2018-06-04 08:38

本文选题：Clarus可视管芯 + 气管插管　；参考：《广州中医药大学》2017年硕士论文

【摘要】：第一部分:Clarus可视管芯视频法和颈前光斑法引导气管插管的临床观察目的:观察Clarus可视管芯引导气管插管的临床效果,比较视频法和颈前光斑法两种操作技术对Clarus可视管芯引导气管插管的影响。方法:110例ASA 1～11级,拟全麻下行经口气管插管的成年患者,随机分为视频组和颈前光斑组。在常规麻醉诱导后,由同一位熟练运用Clarus可视管芯的麻醉医师运用此工具采用视频法或颈前光斑法行气管插管操作。记录各组气管插管操作总时间、确定声门或气管环的时间、插管次数、插管成功率、血流动力学改变、插管相关并发症情况。结果:颈前光斑组和视频组插管操作中位时间为28.67s和29.72s,其中颈前光斑组确认声门或气管环的时间较视频组缩短,两组差异具有统计学意义(P0.05)。颈前光斑组插管总成功率高于视频组(100%VS 96.15%)。其中视频组有2例插管失败,改用颈前光斑法操作后顺利插管成功。两组插管操作引起的血流动力学变化相近。结论:Clarus可视管芯引导气管插管,具有方便快捷、可操性强、对血流动力学影响小等优点。对比视频法,颈前光斑法通过对体表甲状软骨处颈前光点的判断,能直接将Clarus可视管芯的前端移动到声门附近,缩短确认声门及气管环结构的时间并提高插管成功率。但颈前光斑法为半盲探操作技术,在临床中仍应根据病人具体情况选择合适的操作方法以减少不必要的盲探损伤。第二部分:视频法和颈前光斑法对Clarus可视管芯气管插管学习曲线的影响目的:比较视频法和颈前光斑法两种操作技术对Clarus可视系统管芯引导气管插管的学习曲线的影响。方法:选取能熟悉运用直接喉镜但无Clarus可视管芯及其类似工具运用经验的第一二年的麻醉科住院医师共10名为操作者,使用随机数字表法将其分配为颈前光斑操作组和视频法操作组,经过正式培训后,学员使用Clarus可视管芯采用相应的操作技术对择期全麻手术患者进行插管。记录每个学员完成25例患者气管插管的操作时间,插管相关并发症情况,统计插管成功率,用累积和(CUSUM)的方法建立学习曲线,最后各组累加每一位学员每一例操作时累积和的总和,作出两组总体学习曲线图。应用曲线多项式拟合程序得出插管例数与累积和值的曲线方程及曲线函数图,算出掌握相应插管技术所需的最少例数。结果:两组学员年龄、性别、受教育程度无统计学差异。视频法操作组学员掌握插管技术最少需要17例,颈前光斑组为11例,颈前光斑组学习曲线优于视频法操作组(P0.05)。两组学习曲线峰值前操作平均间隔时间及学习曲线峰值后插管退镜操作时间无明显统计学差异(P0.05)。结论:运用Clarus可视管芯行气管插管是一项学习曲线短、操作上手快的实用性技能。对于正常气道,采用颈前光斑技术时Clarus可视管芯的学习曲线优于视频法,该技术更适于初学者的学习训练,值得在麻醉医生及急救医护人员学习和推广。
[Abstract]:The first part: the clinical observation of Clarus visual tube core video method and anterior cervical spot method to guide tracheal intubation: observe the clinical effect of Clarus visual tube core guided tracheal intubation, compare the effect of two kinds of video and anterior cervical spot method on the Clarus visual tube core guided tracheal intubation. Methods: 110 cases of ASA 1~11, general anesthesia under general anesthesia The adult patients treated with oral tracheal intubation were randomly divided into video group and anterior cervical spot group. After routine anesthesia induction, the same anesthetized anesthettic with Clarus visual tube core used video or anterior cervical spot method to perform tracheal intubation. Record the total time of tracheal intubation and determine the time of glottis or tracheal ring. The number of intubation, the success rate of intubation, the change of hemodynamics, and the complications related to intubation. Results: the position time of the anterior cervical spot group and the video group was 28.67s and 29.72s, and the time of the anterior cervical spot group confirmed the glottis or the tracheal ring shorter than the video group, and the two groups were statistically significant (P0.05). The intubation assembly of the anterior cervical spot group was significant. The power of the video group was higher than that of the video group (100%VS 96.15%). In the video group, there were 2 cases of failure of intubation and successful intubation after the operation of the anterior cervical spot method. The hemodynamic changes caused by the two groups of intubation were similar. Conclusion: Clarus visual tube core guided tracheal intubation is convenient, fast, strong, and small influence on hemodynamics. Frequency method, the anterior cervical spot method can directly move the front of the Clarus visual tube to the glottis by judging the anterior cervical spot at the surface of the thyroid cartilage, which can shorten the time to confirm the structure of the glottis and the trachea and improve the success rate of intubation. But the anterior cervical spot method is a semi blind exploration technique, and should be selected according to the patient's specific condition in clinical. The second part: the effect of the video method and the anterior cervical spot method on the learning curve of the Clarus tube core tracheal intubation: comparison of the effect of two methods of video and anterior cervical spot on the learning curve of the tube guided tracheal intubation of the Clarus visual system. A total of 10 inpatients in the first two years of Anesthesiology with direct laryngoscope but without Clarus visual tube core and its similar tools were used as operators in the first two years of anesthesiology. They were assigned to the anterior cervical spot operation group and the video operation group by the random digital table method. After formal training, the students used the corresponding operation techniques of the Clarus visual tube for the selection. Patients undergoing general anesthesia were intubated. The operation time of 25 cases of tracheal intubation was recorded by each cadet, the complications of intubation, the success rate of intubation, and the cumulative and (CUSUM) methods were used to establish the learning curve. At last, the cumulative sum of each student was added to each case, and two groups of overall learning curves were made. The curve polynomial fitting program was used to obtain the curve equation and curve function diagram of the number of intubation and accumulation and value, and the minimum number of cases needed to master the corresponding intubation technology was calculated. Results: there was no statistical difference between the two groups of students' age, sex and education. The minimum requirement for intubation in the video operation group was 17 cases, and the anterior cervical spot group was 11 cases. The learning curve of the anterior cervical spot group was better than the video operation group (P0.05). There was no significant difference between the two groups of learning curves before peak time and the peak of learning curve. Conclusion: the use of Clarus visual tube core for tracheal intubation is a short learning curve and a practical skill to operate quickly. In the normal airway, the learning curve of the Clarus visual tube core is better than the video method when using the anterior cervical spot technique. This technique is more suitable for the learning and training of the beginners. It is worth learning and popularizing in the anesthesiologist and first aid medical staff.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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