CAJ | 학술논문

目的通过与盲探法比较,评价超声引导经鼻气管插管用于口腔颌面部手术患者的价值.方法择期口腔颌面部手术患者40例,ASA分级Ⅰ或Ⅱ级,年龄18～75岁,体重45～90 kg,性别不限.采用随机数字表法,分为2组(n=20):盲探组(B组)和超声组(U组).常规气道表面麻醉和镇静后,保留患者自主呼吸,实施经鼻气管插管.B组以听呼吸气流声来调整导管前端至声门口,在气流声最强吸气相时插入气管导管;U组选用线阵探头(频率7～15 MHz),在甲状软骨窗上可看到声门扩张和导管钢丝插入的声像.于气管插管前、气管插管成功后即刻、1、3、5 min时记录MAP、HR及SpO2,记录气管插管反应的发生情况.记录首次气管插管成功情况,气管插管次数及气管插管时间及术后咽痛、声音嘶哑等并发症的发生情况.结果与B组比较,U组气管插管次数减少,气管插管时间缩短,首次气管插管成功率升高,气管插管失败率、咽痛和声音嘶哑的发生率降低(P＜0.05),血流动力学指标和气管插管反应的发生率比较差异无统计学意义(P＞0.05).所有患者对气管插管过程无知晓.结论与盲探法比较,超声引导经鼻气管插管用于口腔颌面部手术患者可提高首次气管插管成功机率,减少气管插管次数,缩短气管插管时间,且安全、便捷,有显著临床价值.
목적 통과여맹탐법비교,평개초성인도경비기관삽관용우구강합면부수술환자적개치.방법 택기구강합면부수술환자40례,ASA분급Ⅰ혹Ⅱ급,년령18～75세,체중45～90 kg,성별불한.채용수궤수자표법,분위2조(n=20):맹탐조(B조)화초성조(U조).상규기도표면마취화진정후,보류환자자주호흡,실시경비기관삽관.B조이은호흡기류성래조정도관전단지성문구,재기류성최강흡기상시삽입기관도관;U조선용선진탐두(빈솔7～15 MHz),재갑상연골창상가간도성문확장화도관강사삽입적성상.우기관삽관전、기관삽관성공후즉각、1、3、5 min시기록MAP、HR급SpO2,기록기관삽관반응적발생정황.기록수차기관삽관성공정황,기관삽관차수급기관삽관시간급술후인통、성음시아등병발증적발생정황.결과 여B조비교,U조기관삽관차수감소,기관삽관시간축단,수차기관삽관성공솔승고,기관삽관실패솔、인통화성음시아적발생솔강저(P＜0.05),혈류동역학지표화기관삽관반응적발생솔비교차이무통계학의의(P＞0.05).소유환자대기관삽관과정무지효.결론 여맹탐법비교,초성인도경비기관삽관용우구강합면부수술환자가제고수차기관삽관성공궤솔,감소기관삽관차수,축단기관삽관시간,차안전、편첩,유현저림상개치.
Objective To evaluate the value of ultrasound-guided nasotracheal intubation in the patients undergoing oral maxillofacial surgery by comparing with blind intubation.Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 18-75 yr,weighing 45-90 kg,scheduled for elective oral maxillofacial surgery,were randomly divided into blind intubation group (group B,n =20) and ultrasound group (group U,n =20) according to a random number table.Nasotracheal intubation was performed after routine topical analgesia and conscious sedation.The front end of catheter was adjusted to the aditus glottidis according to the sound of respiratory air,and tracheal intubation was placed when the strongest inspiratory phase appeared in group B.A linear array probe (frequency 7-15 MHz) was used,and the images of glottis expansion and wired catheter insertion were visualized in the thyroid cartilage window in U group.Before intubation and at 0,1,3 and 5 min after successful intubation,mean arterial pressure (MAP),HR and SpO2 were recorded.The development of responses to intubation was recorded during intubation.The successful intubation at first attempt,the number of intubation,intubation time,and postoperative complications such as sore throat or hoarseness were recorded.Results Compared with group B,the number of intubation was significantly reduced,intubation time was shortened,the rate of successful intubation at first attempt was increased,the failure rate of intubation and incidence of sore throat and hoarseness were decreased,and no significant changes were found in the parameters of hemodynamics and incidence of responses to intubation in group U.No intraoperative awareness of intubation occurred in patients.Conclusion Compared with blind intubation,ultrasound-guided nasotracheal intubation can raise the probability of successful intubation at first attempt,reduce the number of intubation,and shorten intubation time,and it is safe and convenient and provides significant value clinically for the patients undergoing oral maxillofacial surgery.