困难气管插管的临床经验总结

目的 总结困难气管插管的经验和教训，为麻醉提供借鉴。方法 回顾性分析２８２５例施择期整形我科手术患者困难气管插管的临床资料，造成困难插管的原因有：头后仰活动受限（１１６９例），张口活动受限（８８９例），头后仰活动受限复合张口活动受限（６９８例）和小凳畸形（６９例）。全部患者的喉头显露均为Ⅱ级或Ⅱ级以上，其中４３９例采用神经安定镇痛－口咽表面麻醉，６２９例采用脉麻醉药镇静，小剂量肌松药麻醉，１７５７

The summarization of clinical experience of difficult tracheal intubation

OBJECTIVE: To summarize our experiences and lessons of difficult tracheal intubation for clinical anesthesia reference. METHODS: We had done a retrospective analysis of clinical data on difficult tracheal intubation in 2,825 patients undergoing elective plastic surgery with anesthesia. The main causes of difficult tracheal intubation were the limitations of neck extension (n = 1,169), mouth opening (n = 889), both neck extension and mouth opening (n = 698), and micromaxillary deformity (n = 69). By the Cormack's classification, all the patients had the laryngeal exposure of grade II or more. The tracheal intubations were done under neuroleptanalgesia combined with topical spray of local anesthetic in 439 patients, intravenous anesthesia of sedative drugs and nondepolarizing relaxants of subnormal doses in 629 subjects, and total intravenous or inhaled anesthesia in 1,757 cases, respectively. RESULTS: The difficult tracheal intubations were completed using blind nasal intubations in 142 patients, blind oral intubations with direct laryngoscope in 2,377 patients, oral intubations with fiberoptic stylet rigid laryngoscope in 186 patients, and oral or nasal intubations with flexible fiberoptic bronchoscope in 72 patients. The incidence of successful intubation was 99.7%. The common complication of intubation was airway trauma and its incidence was 19.3% in all the patients. Anesthetic techniques could affect significantly the intubation time and the incidences of complications in the patients with difficult intubation. CONCLUSIONS: By the improvement of anesthetic methods and common intubation techniques, the intubation time and the incidence of complications in the patients with difficult intubations were reduced.