CAJ | 학술논문

目的评价颈椎手术患者i-gel喉罩辅助纤维支气管镜引导气管插管的效果.方法择期全麻气管插管的颈椎手术患者40例,ASA分级Ⅰ或Ⅱ级,性别不限,年龄36～62岁,体重57～78 kg,身高165～177 cm,Mallampati分级Ⅰ～Ⅲ级,随机分为2组(n=20):口咽通气道辅助FOB引导气管插管组(O组)和i-gel喉罩辅助FOB引导气管插管组(I组).麻醉诱导后,进行气管插管.记录气管插管时间、纤维支气管镜咽部解剖结构显露分级、气管插管置人情况;记录气管插管期间高血压、心动过速和低氧血症的发生情况;记录拔除喉罩带血和术后咽喉部不良反应的发生情况.结果 i-gel喉罩均1次置入成功,置入时间为(10±3)s,两组气管插管成功率均为100%;与O组比较,I组气管插管时间缩短,1次气管插管成功率升高,纤维支气管镜咽部解剖结构显露分级升高(P＜0.05).两组气管插管期间血液动力学稳定,均未发生高血压和心动过速和低氧血症,I组仅1例喉罩粘血,两组均未见其他不良反应发生.结论颈椎手术患者i-gel喉罩辅助纤维支气管镜引导气管插管不仅可确保有效的通气,而且可提高引导气管插管成功机率,缩短操作时间.
목적 평개경추수술환자i-gel후조보조섬유지기관경인도기관삽관적효과.방법 택기전마기관삽관적경추수술환자40례,ASA분급Ⅰ혹Ⅱ급,성별불한,년령36～62세,체중57～78 kg,신고165～177 cm,Mallampati분급Ⅰ～Ⅲ급,수궤분위2조(n=20):구인통기도보조FOB인도기관삽관조(O조)화i-gel후조보조FOB인도기관삽관조(I조).마취유도후,진행기관삽관.기록기관삽관시간、섬유지기관경인부해부결구현로분급、기관삽관치인정황;기록기관삽관기간고혈압、심동과속화저양혈증적발생정황;기록발제후조대혈화술후인후부불량반응적발생정황.결과 i-gel후조균1차치입성공,치입시간위(10±3)s,량조기관삽관성공솔균위100%;여O조비교,I조기관삽관시간축단,1차기관삽관성공솔승고,섬유지기관경인부해부결구현로분급승고(P＜0.05).량조기관삽관기간혈액동역학은정,균미발생고혈압화심동과속화저양혈증,I조부1례후조점혈,량조균미견기타불량반응발생.결론 경추수술환자i-gel후조보조섬유지기관경인도기관삽관불부가학보유효적통기,이차가제고인도기관삽관성공궤솔,축단조작시간.
Objective To evaluate the efficacy of fiberoptic bronchoscope (FOB)-guided tracheal intubation with laryngeal mask airway i-gel (LMA i-gel) in patients undergoing cervical spine surgery. Methods Forty ASA Ⅰ or Ⅱ patients, aged 36-62 yr, weighing 57-78 kg, scheduled for cervical spine surgery under general anesthesia, were randomly divided into 2 groups (n = 20 each): FOB-guided tracheal intubation with oropharynx ventilation tube group (group O) and FOB-guided tracheal intubation with LMA i-gel (group I). Anesthesia was induced with midazolam 0.05 mg/kg, propofol 2 mg/kg, fentanyl 2-3 μg/kg and rocuronium 0.9 mg/kg. The intubation time, fiberoptic bronchoscope score, the number of successful intubation, hypertension, tachycardia and hypoxemia were recorded. All the patients were followed up postoperatively for adverse effects like sore throat or hoarseness, etc. Results The rate of successful LMA i-gel placement at first attempt was 100%, placement time was (10 + 3) s, and the rate of successful intubation in the two groups was 100%. The intubation time was significantly shorter, the rate of successful intubation at first attempt and fiberoptic bronchoscope score were significantly higher in group I than in group O (P ＜ 0.05). Hypertension, tachycardia and hypoxemia were not found in the two groups. There was no significant difference in the incidence of adverse effects between the two groups (P ＞0.05). Conclusion FOB-guided tracheal intubation with LMA i-gel can provide adequate ventilation during operation, improve the success rate of FOB-guided intubation and shorten the intubation time in patients undergoing cervical spine surgery.