光棒引导经鼻气管内插管在困难气道患者气管插管中的应用及其效果评价

目的：探讨光棒引导经鼻气管内插管用于口腔颌面外科困难气道患者气管插管
中的有效性，为困难气道的管理提供新方法。方法：ASA Ⅰ或Ⅱ级困难气道且拟行经鼻气管
插管的患者76例，随机均分为光棒引导组(光棒组)和盲探组，每组38例。光棒组借助颈
前光点引导进行插管，而盲探组依靠患者的呼吸声引导插管。比较2组患者插管成功率、插管时间、
插管期间平均动脉压(MAP)和心率(HR)的变化及术后插管并发症的发生率。结果：光棒
组患者插管成功率（89.5%，34/38）高于盲探组（71.1%，27/38）(P<0.05)；插管时间［(89.9±26.8) s］短
于盲探组［(134.9±32.8) s］（P<0.001）；光棒组术后咽痛发生率（14.7%，5/34）亦低于盲探组（40.7%，11/27）（P<0.05）;声音嘶哑和鼻出血发生率组间比较差异无统计学意义(P>0.05)。插管期间光棒组患者插管中和插管1 min MAP值低于盲探组，2组患者各时间点HR差异无统
计学意义（P>0.05）；结论：光棒引导经鼻气管内插管简单、实用，较经鼻盲探插管成功率高，血流动力学平稳，且不良反应少，是困难气道患者行经鼻气管插管的有效途径之一。

Application and effectiveness evaluation of nasotracheal intubation using lightwand in patients with difficult airways during intubation

Objective To evaluate the effectiveness of nasotracheal intubation using lightwand in patients with difficult airways in oral and maxillofacial surgery,and to provide a new method for difficult airway management.Methods 76 ASAⅠor Ⅱ grade patients with difficult airways who required nasotracheal intubation were randomly divided into using lightwand group(lightwand group)(n=38) and blind intubation group(n=38).The intubation procedure was guided by the light spot at neck in lightwand group while in blind intubation group it was guided by the patients' breathing sound.The intubation success rate,intubation time,changes of mean arterial pressure(MAP) and heart rate(HR) and postoperative complications of the patients were compared between two groups.Results In lightwand group,the intubation success rate(89.5%,34/38) was obviously higher than blind intubation group(71.1%,27/38)(P<0.05);the intubation time [(89.9±26.8) s] was significantly lower than blind intubation group [(134.9±32.8) s](P<0.001);the postoperative incidence rate of pharyngalgia(14.7%,5/34) was significantly lower than blind intubation group(40.7%,11/27)(P<0.05);there were no significant differences of the incidence rates of hoarseness and epistaxis between two groups(P>0.05);the MAP values of patients were lower than blind intubation group during intubation period and 1 min after intubation,and there were no significant differences of HR of patients at different time points between two groups(P>0.05).Conclusion To the patients with difficult airways,the nasotracheal intubation using lightwand is superior to blind intubation with higher success rate,more stable haemodynamic responses,and less postoperative complications.The technique could be used as a simple and practical approach for nasotracheal intubation in difficult airways.