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Received:April 12, 2021 Published Online:November 20, 2021
Received:April 12, 2021 Published Online:November 20, 2021
中文摘要: 目的 探讨纤维支气管镜引导联合麻醉法在强直性脊柱炎患者清醒气管插管中的临床应用。方法 选取南京鼓楼医院2017年2月至2020年8月行强直性脊柱炎后路截骨矫形术患者43例,随机分为P组(21例)和L组(22例)。P组患者给予利多卡因气雾剂咽喉部喷雾,L组患者通过纤支镜引导分别给予声门和主气管利多卡因表面麻醉。比较两组患者入室时(T1)、气管插管前(T2)、气管插管即刻(T3)及气管插管后1 min(T4)、3 min(T5)时HR、MAP和SpO2,记录插管时间、首次插管成功率及插管相关并发症。结果 与T1时比较,两组患者T3~T5时HR增快,MAP增高(P<0.05);与L组比较,P组在T3~T5 HR增快,MAP增高(P<0.05);与T1时比较,P组在T4~T5时SpO2降低(P<0.05);与L组比较,P组在T4~T5 SpO2降低(P<0.05)。L组患者气管插管时间短于P组[(45.8±8.8)s vs (71.0±10.1)s,P<0.01],首次气管插管成功率高于P组(90.9% vs 47.6%,P<0.01)。P组患者气管插管引起口咽出血和咽痛发生率高于L组(P<0.05)。结论 纤维支气管镜引导联合麻醉法在强直性脊柱炎患者清醒气管插管中可有效降低应激反应,且减少插管相关并发症。
Abstract:Objective To investigate the application of fiberoptic bronchoscopy guided combined anesthesia under awake intubation in ankylosing spondylitis patients. Methods From February 2017 to August 2020, 43 patients with ankylosing spondylitis underwent posterior osteotomy and orthopedics in Nanjing Drum Tower Hospital were randomly divided into group P (21 cases) and group L (22 cases). Patients in group P were given lidocaine aerosol throat spray, and patients in group L were given topical anesthesia with lidocaine for glottis and main trachea through bronchoscopy. HR, MAP and SpO2 were compared between the two groups at the time entering the room (T1), before endotracheal intubation (T2), immediately after endotracheal intubation (T3), 1 min after endotracheal intubation (T4) and 3 min after endotracheal intubation (T5). The time of intubation, the first intubation success rate and intubation-related complications were recorded. Results Compared with T1, HR and MAP increased at T3-T5 in two groups (P<0.05). Compared with group L, HR and MAP increased at T3-T5 in group P (P<0.05); Compared with T1, SpO2 decreased at T4-T5 in group P (P<0.05); Compared with group L, SpO2 decreased at T4-T5 in group P (P<0.05). The tracheal intubation time of group L was shorter than that of group P [(45.8±8.8) s vs (71.0±10.1) s,P<0.01], and the success rate of first tracheal intubation was higher than that of group P (90.9% vs 47.6%,P<0.01). The incidence of oropharyngeal bleeding and sore throat caused by tracheal intubation in group P was higher than those in group L (P<0.05).Conclusion Fiberoptic bronchoscopy guided combined anesthesia can effectively reduce the stress response and reduce intubatio-related complications in patients with ankylosing spondylitis awake endotracheal intubation.
文章编号: 中图分类号:R614 文献标志码:A
基金项目:国家自然科学青年基金(81500955)
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