CAJ | 학술논문

目的评价颈椎手术患者喉罩辅助纤维支气管镜引导气管插管的效果.方法择期行前路颈椎手术患者40例,性别不限,年龄18～55岁,体重50～75 kg,ASA分级Ⅰ或Ⅱ级,Mallampatis分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机分为2组(n=20):纤维支气管镜引导气管插管组(FOB组)和喉罩辅助纤维支气管镜引导气管插管组(LMA组).麻醉诱导后,进行气管插管.记录气管插管时间和气管导管置入情况；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LMA组喉罩置入情况、置入时间和拔除气管导管时喉罩移位情况.记录拔除喉罩带血和术后咽喉部不良反应的发生情况.结果喉罩1次置入成功率为90％,置入时间为(13±3)s.两组气管插管成功率均为100％.与FOB组比较,LMA组气管插管时间缩短,1次气管插管成功率升高(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、心动过速和低氧血症.LMA组气管导管拔除时有8例(40％)发生喉罩移位；拔除喉罩时1例发生喉罩带血；术后1例发生咽部轻微疼痛；两组均未见其它不良反应的发生.结论颈椎手术患者喉罩辅助纤维支气管镜引导气管插管不仅可确保有效通气,还可提高引导气管插管成功率,明显缩短气管插管时间.
목적 평개경추수술환자후조보조섬유지기관경인도기관삽관적효과.방법 택기행전로경추수술환자40례,성별불한,년령18～55세,체중50～75 kg,ASA분급Ⅰ혹Ⅱ급,Mallampatis분급Ⅰ혹Ⅱ급.채용수궤수자표법,장환자수궤분위2조(n=20):섬유지기관경인도기관삽관조(FOB조)화후조보조섬유지기관경인도기관삽관조(LMA조).마취유도후,진행기관삽관.기록기관삽관시간화기관도관치입정황；기록기관삽관기간고혈압、심동과속화저양혈증적발생정황；기록LMA조후조치입정황、치입시간화발제기관도관시후조이위정황.기록발제후조대혈화술후인후부불량반응적발생정황.결과 후조1차치입성공솔위90％,치입시간위(13±3)s.량조기관삽관성공솔균위100％.여FOB조비교,LMA조기관삽관시간축단,1차기관삽관성공솔승고(P＜0.05).량조기관삽관기간혈액동역학은정,균미발생고혈압、심동과속화저양혈증.LMA조기관도관발제시유8례(40％)발생후조이위；발제후조시1례발생후조대혈；술후1례발생인부경미동통；량조균미견기타불량반응적발생.결론 경추수술환자후조보조섬유지기관경인도기관삽관불부가학보유효통기,환가제고인도기관삽관성공솔,명현축단기관삽관시간.
Objective To evaluate the efficacy of fiberoptic bronchoscope( FOB )-guided tracheal intubation with laryngeal mask airway (LMA) in patients undergoing anterior cervical spine surgery.Methods Forty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-55 yr,weighing 50-75 kg,mallampatis Ⅰ or Ⅱ,scheduled for anterior cervical spine surgery under general anesthesia,were randomly divided into 2 groups( n =20 each): FOBguide tracheal intubation (group FOB) and FOB-guided tracheal intubation with LMA group (group LMA).Anesthesia was induced with mindazolam 0.04 mg/kg,fentany 3-4 μg/kg,cis-atracuriun 0.2 mg/kg and propofol 2 mg/kg.Tracheal intubation was performed at 3 min after cis-artracurium iv.Auditory evoked potential index was maintained at 10-20.The intubation time,the number of successful intubation,hypertension,tachycardia and hypoxemia were recorded.The number of successful LMA placement,LMA placement time and LMA shift after extubation were recorded.Blood stain at LMA removal and complications were also recorded.Results The rate of successful LMA placement at first attempt was 90％ and placement time was ( 13 ± 3) s.The rate of successful intubation in the both groups was 100％.The intubation time was significantly shorter and the rate of successful intubation at first attempt was higher in group LMA than in group FOB ( P ＜ 0.05).Hypertension,tachycardia and hypoxemia were not found in the two groups.The number of LMA shift was 8 (40％).The number of blood stain and slight sore throat was 1 respectively in group LMA.There was no other complications in the both groups.Conclusion FOB-guided tracheal intubation with LMA can provide effective ventilation during operation,improve the success rate at first attempt and shorten the intubation time in patients undergoing cervical spine surgery.