导管加温后纤维支气管镜引导经鼻建立人工气道的临床应用

目的 探讨气管插管导管加温软化后再经纤维支气管镜(纤支镜)引导经鼻建立人工气道行机械通气支持的优越性和安全性.方法 209例接受纤支镜引导经鼻置管行机械通气支持治疗的患者被随机分为加温组(105例,置管前先将导管加温到52 ℃)和常规组(104例,置管前导管温度23～26 ℃),导管由纤支镜引导经鼻建立人工气道.加温组置管前不应用麻黄素喷鼻.结果 ①导管加温组首次置管成功者所需时间(14.48±8.31)s,99例]明显短于常规组(23.85±11.97)s,96例,P＜0.01).②加温组清醒状态下患者的首次置管成功率为100.0%(28/28例),显著高于常规组(87.5%,21/24例,P＜0.05).③加温组首次置管成功者30 s内置管成功率为93.9%(93/99例),明显高于常规组(68.6%,66/96例,P＜0.01).④加温组首次置管成功者中导管向气管内推送困难的发生率为5.05%(5/99例),常规组为32.29%(31/96例),两者比较差异有显著性(P＜0.01).⑤加温组首次置管成功者中鼻出血发生率为4.0%(4/99例),明显低于常规组(15.6%,15/96例),差异有显著性(P＜0.01).⑥加温组清醒状态下首次置管成功者的鼻出血发生率为3.6%(1/28例),常规组为28.6%(6/21例),两者比较差异有显著性(P＜0.05).结论 导管加温后纤支镜引导经鼻建立人工气道,在置管前鼻腔黏膜表面无需使用缩血管药物,插管前准备时间缩短,避免了药物引发的心血管反应;提高了清醒状态下患者对插管操作的依从性和置管成功率.

Establishment of artificial airway with a thermal-softened nasotracheal tube guided by fiberoptic bronscope

OBJECTIVE: To assess superiority and safety of nasotracheal intubation with a thermal-softened tube guided by fiberoptic bronchoscope to establish an artificial airway for the institution of mechanical ventilation. METHODS: A total of 209 patients were randomly allocated to two groups: "treated tube" group (52 centigrade treated tube group, n=105), common tube group (the tube was prepared at room temperature 23-26 centigrade, n=104). Nasotracheal intubation was guided by a fiberoptic bronchoscope to establish an artificial airway. RESULTS: (1)The required time of the first successful nasotracheal intubation in the "treated tube" group (14.48+/-8.31) seconds, 99 cases] was significantly shorter than in the common tube group (23.85+/-11.97) seconds, 96 cases, P<0.01]. (2)Ratio of successful intubation in the "treated tube" group under conscious condition was higher than that of the common tube group 100% (28/28 cases) vs. 87.5% (21/24 cases), P<0.05]. (3) Ratio of successful intubation in 30 seconds in the "treated tube" group was significantly higher than that of the common tube group 93.9% (93/99 cases) vs. 68.6% (66/96 cases), P<0.01]. (4)The incidence of difficult intubation in the "treated tube" group 5.05% (5/99 cases)] was significantly lower than that of the common tube group 32.29%, (31/96 cases), P<0.01]. (5)The incidence of epistaxis in the first successful nasotracheal intubation in the "treated tube" group 4.0% (4/99 cases)] was significantly lower than that of the common tube group 15.6%,(15/96 cases), P<0.01]. (6)The incidence of epistaxis during nasotracheal intubation in conscious patients was lower in the "treated tube" (3.6%, 1/28 cases) group than that of the common tube group 28.6%, (6/21 cases), P<0.05]. CONCLUSION: The use of a thermal-softened nasotracheal tube to intubate guided by a fiberoptic bronchoscope to establish an artificial airway shortened preparation time before intubation. It is not necessary to use a vasoconstrictor for nasal mucosa before intubation, therefore cardiovascular effects due to the drugs can be avoided. It increases the willingness of conscious patients to accept the procedure and successful rate of the first intubation.