摘要
背景对于麻醉医生来讲，提高气道病变患者围术期管理计划的水准极具挑战性。由于缺乏呼吸道结构病变的详细信息，临床医生通常会考虑采用清醒插管（awake intubation，AI）以免产生不良后果。在一项非对照研究中，术前的麻醉评估包含气道病变的内镜检查，以便制定更好的气道管理计划。我们将研究对存在气道病变的患者进行内镜检查是否会改善麻醉医生对这些患者气道管理的方式。方法拟行呼吸道诊断或者治疗的择期手术患者入选本研究。患者经标准气道检查后，记录其气道管理计划。进入手术室前，患者鼻孔滴注血管收缩药和局麻药，记录患者经过术前内镜下气道检查（preoperative endoscopic airway examination，PEAE）后的气道管理计划及最终施行的气道管理计划。在4个月或更久以后，由不认识患者的医生来查看PEAE的视频记录，并且重新记录PEAE计划，以此来检测操作者有无偏倚。结果研究包括138例患者，尽管最初计划在44例患者中进行清醒插管，但只有16例患者PEAE后实行了诱导前控制气道（P〉0．05）；另外94例患者的最初计划为麻醉诱导后控制气道，但PEAE发现8例患者有意料不到的严重气道病变，进行了清醒插管。PEAE后的气道管理计划和4个月或更久舌制定的计划相比没有显著性差异。结论研究中有26％的患者显示PEAE影响气道管理计划。我们相信PEAE将成为气道病变患者术前评估的必要组成部分；当能提供更好的气道结构信息时，气道内镜检查能减少不必要清醒插管例数。PEAE也适用于麻醉诱导时有气道管理失败风险的患者。
BACKGROUND： Development of a perioperative plan for management of patients with airway pathology is a challenge for the anesthesiologist. Lack of comprehensive information regarding the architecture of airway lesions often leads the dinidan to consider techniques of awake intubation （AI） to avoid catastrophic outcomes in this population. In one uncontrolled trial, endoscopic visualization of the airway lesion was included in the preoperative anesthetic assessment for planning of airway management. We sought to determine whether visual inspection of airway pathology would change the anesthesiologist＇s approach to the management of these patients. METHODS： Patients presenting for elective diagnostic or therapeutic airway procedures were included in the study. After a standard examination of the airway, a management plan was recorded. Before entering the operating room, and after brief preparation of the nares with a vasoconstrictor and local anesthetic, the patients underwent a preoperative endoscopic airway examination （PEAE） and a final airway management plan was recorded and implemented. Four or more months after the procedure, video recordings of the PEAE were reviewed without other patient identifiers and a remote PEAE plan was recorded, to test for operator bias. RESULTS： One hundred thirty-eight patients were studied. Although AI was initially planned in 44 patients, only 16 of these patients underwent preinduction airway control after PEAE （P 〉 0.05 ）. Additionally, of the 94 patients for whom the initial plan was airway control after the induction of anesthesia, 8 patients were found to have unexpectedly severe airway pathology on PEAE, and also underwent AI. There was no significant difference between the post-PEAE airway management plan and the remote plan recorded 4 or more months later. CONCLUSIONS： In 26% of the patients studied, PEAE affected the planned airway management. We believe that PEAE can be an essential component of the preoperative assessment of patients with airway
出处
《麻醉与镇痛》
2013年第2期70-76,共7页
Anesthesia & Analgesia
