摘要
目的比较Cookgas插管型喉罩(CILA)和Fastrach插管型喉罩(FT-LMA)联合纤维光导支气管镜(FOB)在预测重度困难气道管理中的临床应用效果。方法择期在全身麻醉下行整形外科手术的预测重度困难气管插管患者(同时具有甲颏距离<60 mm;门齿间距<35 mm;Mallampati分级Ⅲ或Ⅳ级)60例,随机分为CILA组(n=30)和FT-LMA组(n=30)。麻醉诱导后,经口置入CILA或FT-LMA,获得喉罩最佳通气位置后,采用FOB经CILA或FT-LMA寻找声门,并引导完成气管插管。主要观察指标是喉罩置入和FOB引导气管插管成功与否,以及成功操作的次数和所用时间。结果 CILA组30例患者和FT-LMA组27例患者成功置入喉罩,在3例FT-LMA置入失败患者,改用CILA成功完成喉罩置入;CILA组有26例患者由FOB引导首次气管插管成功,4例患者在第2次成功插管。在成功置入FT-LMA的27例患者中,有20例FOB引导1次插管成功,4例2次成功,3例失败,改置入CILA后,2例由FOB引导首次成功,1例2次成功插管。与CILA组比较,FT-LMA组喉罩置入时间[(23.9±17.5)s比(35.3±12.8)s]显著延长(P<0.05),而FOB经CILA和FT-LMA引导气管插管时间[(48.6±13.5)s比(53.2±14.2)s]及喉罩退出时间[(40.4±10.2)s比(38.5±11.3)s]差异无统计学意义(P>0.05)。两组患者在插管过程中以及术后随访未见明显损伤。结论 CILA和FT-LMA联合FOB均可安全、有效地应用于预测重度困难气管插管患者,但在重度面颈瘢痕挛缩和颈部置有巨大扩张器患者,CILA置入和辅助FOB引导气管插管的成功率均优于FT-LMA。
Objective To compare the clinical effectiveness of fiberoptic bronchoscope （FOB） - guided intuhation through the Cookgas intubating laryngeal airway （CILA） and the Fastrach intubating laryngeal mask airway （FT-LMA） in the management of anticipated difficult airways. Methods Sixty patients with all three difficult intubation criterion （thyromental distance 〈 60 mm, interincisor distance 〈 35 mm, and Mallam- pati class Ⅲ or Ⅳ ） undergoing elective plastic surgery under general anesthesia were randomly allocated into CI- LA group （n --30） and FT-LMA group （n = 30） . After anesthesia being induced and CILA or FT-LMA being inserted, the patients were treated with FOB-guided intubation through CILA or FT-LMA. The success of the in- tubating laryngeal airway （ILA） insertion and FOB-guided intubation, the number of attempts, and the dura- tion of the successful attempt were recorded. Results The ILA was inserted successfully in 30 patients from CILA group and 27 patients from FT-LMA group. Three failed cases in Fr-LMA group were inserted successfully with CILA. In CILA group, the first FOB-guided intubation attempt succeeded in 26 patients, and 4 cases were intu- bated at the second attempt. In 27 patients of FT-LMA group, 20 cases were intubated successfully at the first at- tempt, 4 cases at the second attempt, and 3 cases failed; of these three failed patients, two patients were intu- bated smoothly with FOB through CILA at the first attempt, one was intubated by FOB via CILA at the second at- tempt. The duration of FT-LMA insertion [ （35.3 ± 12. 8） s] was significantly longer when compared with CILA [ （23.9 ±17.5 ） s ] （P 〈 0. 05 ） . However, the duration of FOB-guided intubation through CILA and Fr-LMA [ （48.6±13.5） s vs （53.2±14.2） s] and the time of ILA removal [（40.4±10.2） s vs. （38.5±11.3） s] were not significantly different between these two groups （ P 〉 0. 05 ） . The adverse events during and after intub- tion were not significantly
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2013年第5期477-482,共6页
Acta Academiae Medicinae Sinicae
基金
首都临床特色应用研究基金(D101100050010002)~~
关键词
喉面罩
纤维光导支气管镜
困难气道
气管内插管法
laryngeal mask airway
fiberoptic bronchoscope
difficult airway
endotracheal intubation
