摘要
目的分析复合张口受限的多因素可疑困难气道患者入手术室后行气道确诊并指导建立气道方案的安全性及临床应用效果。方法收集2018年3月至2023年5月西北妇女儿童医院、空军军医大学第三附属医院共21例依据LEMON气道评估法则评估为复合张口受限的可疑困难气道患者,并在入手术室后行通气能力评分、可视软镜直视气道评分、困难气道综合评分。确诊为非困难气道的患者为N组,确诊为困难气道的患者为D组,统计两组人数,所占比例,分析气道确诊过程、建立气道的方式、结果及建立气道过程中低通气发生的次数、插管的次数,建立气道时间等。结果N组共15例患者,占比71.4%,确诊非困难气道后行静脉快诱导经鼻插管,插管均一次成功,所有患者插管过程中均未发生低通气;D组共6例患者,占比28.6%,确诊困难气道后,纯氧面罩辅助通气,待患者苏醒后行清醒经鼻气管插管,4例患者1次插管成功,2例患者2次插管成功,1例患者在通气能力评估过程中发生一次低通气;N组建立气道的时间(9.3±0.8)min,D组建立气道时间(20.0±2.0)min,差异有统计学意义(P<0.05);所有患者建立气道的时间为(12.0±5.0)min,清醒气管插管时间(12.0±0.7)min。N组患者对麻醉满意占比高于D组,差异有统计学意义(P<0.05);两组均未出现七氟烷诱导和苏醒过程中的躁动。结论复合张口受限的多因素可疑困难气道患者可以安全应用困难气道确诊流程;大部分此类患者并非真正的困难气道;此类患者应用困难气道确诊流程可以大幅减少非必要清醒气管插管;与直接选择清醒气管插管相比,遵循困难气道确诊流程不增加此类患者建立气道时间。
Objectives To analyze the safety and clinical effect of airway diagnosis in multifactor suspicious dificult airway patients with complex mouth restriction after entering the operating room.Methods From March 2018 to May 2023,a total of 21 patients with suspicious difficult airway with complex mouth restriction were collected from the Northwest Women's and Children's Hospital and the Third Affiliated Hospital of Air Force Military Medical University,who were evaluated according to LEMON airway evaluation rule.Ventilation capacity score,airway airway score with soft vision mirror and comprehensive airway score of difficult airway were performed afier admission to the operating room.Patients diagnosed with non-dfficult airway were divided into group N and patients diagnosed with difficult airway were divided into group D.The number and proportion of patients in the two groups were counted,and the process of airway diagnosis,the way of airway establishment,the results,the frequency of hypoventilation during airway establishment,the number of intubation, and the time of airway establishment were analyzed. Results A total of 15 patientsin group N, accounting for 71. 4% , underwent rapid intravenous induction nasal intubation after diagnosis ofnon-difficult airway, and the intubation was successful all the time. No hypoventilation occurred in allpatients during intubation. A total of 6 patients in the group D, accounting for 28.6%, were assisted bypure oxygen mask ventilation after diagnosis of difficult airway, and underwent awake nasotracheal intubationafter recovery. 4 patients were successfully intubated once, 2 patients were successfully intubated twice, and1 patient experienced one hypopnea during the evaluation of ventilation capacity. The airway establishment timeof the group N was (9.3 ±0.8)min, and that of the group D was (20.0 ± 2.0) min, the difference wasstatistically significant (P<0. 05). The airway establishment time of all patients was (12. 0 ± 5. 0) min,and the awake intubation time was (12. 0 ±0.
作者
周万华
王晓菲
荀泽敏
Zhou Wanhua;Wang Xiaofei;Xun Zemin(Department of Anesthesiology,Northwest Women's and Children's Hospital,Xi'an 710061,China;State Key Laboratory of Military Stomatology&National Clinical Research Center for Oral Diseases&Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture,Department of Anethesiology,the Third Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)
出处
《中国医师杂志》
CAS
2024年第10期1530-1534,1539,共6页
Journal of Chinese Physician
关键词
张口受限
多因素可疑困难气道
气道确诊流程
Restricted mouth opening
Multifactorial suspicion of difficult airway
Airway confirmation process
