CAJ | 학술논문

目的比较阻塞性睡眠呼吸暂停综合征(OSAS)患者纤维支气管镜(FOB)辅助下快诱导经口与慢诱导经鼻气管插管的效果.方法择期行悬雍垂腭咽成形术的OSAS合并高血压患者40例,ASAⅡ级,年龄38～64岁,体重82～123 kg,张口度大于2.5 cm,Mallampatis分级Ⅲ或Ⅳ级,随机分为Ⅰ组和Ⅱ组(n=20),分别采用FOB辅助下慢诱导经鼻气管插管和快诱导经口气管插管.于麻醉诱导后即刻和气管插管后即刻记录MAP和HR;记录两组气管插管时间、气管插管成功情况和气管插管期间心动过速、高血压及心肌缺血的发生情况,以及耳鼻喉科医师对气道管理的满意情况.结果 40例患者使用FOB气管插管均成功,Ⅰ组5例气管插管失败,改为Ⅱ组方法后均首次气管插管成功,Ⅱ组气管插管均成功;与Ⅰ组比较,Ⅱ组气管插管成功率升高,麻醉诱导后HR和MAP降低,气管插管期间心动过速、高血压及心肌缺血发生率降低,耳鼻喉科医师满意率升高(P(0.05);Ⅰ组有4例气管拔管后出现鼻出血.结论在FOB辅助下,与慢诱导经鼻气管插管比较,OSAS患者采用快诱导经口气管插管时应激反应小,气管插管成功机率高,可避免气道损伤.
목적 비교조새성수면호흡잠정종합정(OSAS)환자섬유지기관경(FOB)보조하쾌유도경구여만유도경비기관삽관적효과.방법 택기행현옹수악인성형술적OSAS합병고혈압환자40례,ASAⅡ급,년령38～64세,체중82～123 kg,장구도대우2.5 cm,Mallampatis분급Ⅲ혹Ⅳ급,수궤분위Ⅰ조화Ⅱ조(n=20),분별채용FOB보조하만유도경비기관삽관화쾌유도경구기관삽관.우마취유도후즉각화기관삽관후즉각기록MAP화HR;기록량조기관삽관시간、기관삽관성공정황화기관삽관기간심동과속、고혈압급심기결혈적발생정황,이급이비후과의사대기도관리적만의정황.결과 40례환자사용FOB기관삽관균성공,Ⅰ조5례기관삽관실패,개위Ⅱ조방법 후균수차기관삽관성공,Ⅱ조기관삽관균성공;여Ⅰ조비교,Ⅱ조기관삽관성공솔승고,마취유도후HR화MAP강저,기관삽관기간심동과속、고혈압급심기결혈발생솔강저,이비후과의사만의솔승고(P(0.05);Ⅰ조유4례기관발관후출현비출혈.결론 재FOB보조하,여만유도경비기관삽관비교,OSAS환자채용쾌유도경구기관삽관시응격반응소,기관삽관성공궤솔고,가피면기도손상.
Objective To compare the efficacy of orotracheal intubation after rapid induction and nasotracheal intubation after slow induction assisted by fiberoptic bronchoscope (FOB) in patients with obstructive sleep apnea syndrome (OSAS).Methods Forty ASA Ⅱ patients with OSAS and hypertension, aged 38-64 yr, weighing 82-123 kg, undergoing uvulopalatopharyngoplnsty, were randomly allocated into 2 groups (n = 20 each): group Ⅰ awake nasotracheal intubation through FOB after slow induction and group Ⅱ orotracheal intubation through laryngoscope and FOB after rapid induction. MAP and HR were recorded immediately after anesthesia induction and intubation. The intubation time was recorded, and rate of successful intubation, incidences of tschycardia, hypertension and myocardial ischemia during intubation, and satisfactory rate of otolaryngologists with airway management were calculated. Results The rate of successful intubation were significantly higher, MAP and HR after induction were significantly lower, incidences of tachycardia, hypertension and myocardial ischemia during intubation were significantly lower, and satisfactory rate of otolaryngologists was significantly higher in group Ⅱ than in group Ⅰ ( P < 0.05). Four patients in group Ⅰ had nasal bleeding after extubation. Conclusion Orotracheal intubation after rapid induction assisted by FOB provides less hemodynamic response to endotracheal intubation and higher success rate with less injury to the airway in patients with OSAS than nasotracheal intubation after slow induction assisted by FOB.