Shikani可视喉镜在清醒危重患者气管插管中的应用

目的 探讨在清醒危重患者急救中使用Shikani喉镜引导气管插管的可行性,并评价其使用效果.方法 选择2008年1月至2009年6月广州中医药大学第二附属医院收治的神志尚清楚的危重呼衰患者48例,男31例,女17例,年龄21～86岁,平均57岁,所有患者均需气管插管行机械辅助通气.采用非随机对照方法,按进入研究的日期单双数分为Shikani喉镜气管插管组(S组,n=25)和Macintosh喉镜气管插管埘照组(M组,n=23).记录每例的气管插管时间、插管次数以及包括心血管反应剧烈、呛咳、屏气、口咽腔损伤等不良反应或并发症的发生情况.统计分析采用x2检验、秩和检验等.结果 S组1次插管成功率(96.0%)较M组1次插管成功率(60.9%)高,插管时间较对照组(M组)缩短,差异均具有统计学意义(P<0.01).S组的心血管反应剧烈、呛咳、屏气的发生率均较M组少,口咽腔黏膜出血创伤的发生率也较M组小,差异均具有统计学意义(P<0.01).结论 在急危重患者救治中,尤其对于神志清楚的患者,Shikani喉镜引导气管插管具有插管迅速、成功率高、心血管反应轻、损伤小、安全性高的优点,是一种安全、有效的气管插管新技术.     

成人经口气管插管固定方法的应用进展

机械通气技术日渐成为急救与危重病抢救中不可缺少的手段,经口腔气管插管是危重患者进行心肺复苏、抢救呼吸肌麻痹和手术麻醉、开放气道中常用的方法,而气管插管后的安全固定,是维持患者有效通气的保证。气管插管意外拔管其发生率占所有气管插管患者的5．4％～15．5％。如发现不及时或处理不当,患者可因此失去有效呼吸而危及生命,甚至引起医疗纠纷。     

逆向法协同多爱肤固定经口置胃管的临床观察

目的探讨逆向法协同多爱肤固定新生儿经口方式留置胃管的效果。方法将120例以经口方式留置胃管的新生儿随机分为实验组、对照组1和对照组2,每组40例。实验组采用逆向方法协同多爱肤敷料进行胃管的固定。对照组1采用普通胶布对胃管进行传统顺应性方法固定胃管;对照组2采用多爱肤敷料对胃管进行顺应性方法固定;并对三组应用效果进行比较。结果采用多爱肤敷料对经口方式留置胃管的患儿进行逆向法固定更为牢固,其胃管留置的时间较传统顺应性方法固定的长。结论以逆向法协同多爱肤固定经口留置胃管的患儿,保留时间长,胃管不易脱出,多爱肤敷料粘贴皮肤处不会产生刺激,可应用于临床。     

脑电双频谱指数和正中神经体感诱发电位监测窥喉插管应激反应的比较

目的比较脑电双频谱指数和正中神经体感诱发电位监测异丙酚诱导下窥喉插管所致应激反应的可行性和准确性。方法选择16-40岁ASAI-Ⅲ级无神经精神系流疾病患者15例,异丙酚和司可林麻醉后行气管插管,记录插管前、中、后的MnSSEP、BIS、SBP、DBP、HR。结果插管即刻MnS,SEP的P15N20、N20P25波幅增高,插管后N20P25恢复,P15N20仍增高,其余波幅无改变。插管前后MnSSEP各波潜伏期均无改变,并BIS无明显改变。插管即刻和插管后SBP、DBP较插管前增高而HR无明显改变。结论正中神经体感诱发电位的N20P25适于反映气管插管对神经系统的影响,P15N20适于反映气管插管对心血管系统的影响,BIS值不能反映窥喉插管的应激反应。     

罗库溴铵以限时法和预注法行快速气管插管的比较

目的 比较罗库溴铵以限时法和预注法行快速气管插管的条件、肌松效应及对循环系统的影响。方法 限时（Ⅰ、Ⅱ）组诱导前30秒静注0.6mg/kg罗库溴铵,诱导后45秒（I）、60秒（Ⅱ）行气管内插管,预注（Ⅲ）组诱导前2分钟预注0.06mg/kg罗库溴铵（诱导量0.54mg/kg）,诱导后60秒行气管内插管。记录拇内收肌诱发颤搐反应的抑制和恢复过程,评价各组插管效果。结果气管内插管条件各组间无明显差异;气管内插管时T1抑制百分比Ⅲ组明显小于其他各组;各且对循环系统的都很小。结论 罗库溴铵以限时法行快速气管插管较预注法为佳。     

罗库溴铵和阿曲库铵的预注量对相互起效的影响

目的　研究罗库溴铵和阿曲库铵的预注量对相互起效和插管条件的影响。方法　 6 0例患者随机平均分成六组。麻醉诱导用地西泮、硫喷妥钠和芬太尼。Ⅰ组和Ⅳ组分别静注罗库溴铵0 6mg/kg和阿曲库铵 0 5mg/kg ,Ⅱ组和Ⅴ组预注罗库溴铵 0 0 6mg/kg ,Ⅲ组和Ⅵ组阿曲库铵0 0 5mg/kg。 3分钟后Ⅱ组和Ⅲ组静注罗库溴铵 0 5 4mg/kg ,Ⅴ组和Ⅵ组阿曲库铵 0 4 5mg/kg。观察插管量后的起效时间和气管插管条件。结果　Ⅲ组的起效时间为 (6 7 6± 14 2 )秒稍短于Ⅰ组的(73 1± 13 4 )秒和Ⅱ组的 (76 3± 15 3)秒 (P >0 0 5 )。Ⅴ组和Ⅵ组的起效时间为 (93 8± 2 2 4 )秒和(115 8± 14 9)秒 ,比Ⅳ组 (15 6 0± 37 2 )秒的短 (P <0 0 5和P <0 0 1) ,Ⅴ组的起效时间也显著短于Ⅵ组。气管插管条件Ⅴ组较Ⅳ组明显改善。结论　预注罗库溴铵不能使罗库溴铵的起效增快。预注罗库溴铵使阿曲库铵的起效明显增快 ,插管条件改善 ;预注罗库溴铵比预注阿曲库铵对阿曲库铵起效的增快作用更明显     

覆膜气管支架治疗气管狭窄伴气管瘘

目的将覆膜的直管型或分叉型气管支架应用于治疗恶性肿瘤造成的气管狭窄伴气管瘘,以维持呼吸通道和封闭瘘口。方法采用全部或部分覆盖硅橡胶薄膜的不锈钢丝“Z”型支架,使用带导引鞘的三套管支架输送器放置支架。结果9例气管支架均一次放置成功,6例食管内同时放置支架。术后呼吸困难的症状立即缓解,瘘口被封闭。随访观察4～12个月,无明显不良反应。结论采用覆膜直管型或分叉型支架治疗气管狭窄伴气管瘘是安全有效的方法。     

Comparison of two video-assisted techniques for the difficult intubation

BACKGROUND: Two recently developed video-optical intubation devices, the video-optical intubation stylet (VOIS) and the angled video intubation laryngoscope (AVIL) were compared for intubation times and success rate in a simulated difficult tracheal intubation setting. METHODS: Thirty anaesthetists were asked to perform 5 intubation attempts with both techniques. Intubation times were recorded and the subjective degree of difficulty and preference for each technique were requested. RESULTS: Intubation time with the VOIS was shorter (17.4+/-6.8 s) than with the AVIL (22.8+/-13.4 s; P=0.0001). Four of the 150 intubation attempts with the AVIL were scored as unsuccessful, due to prolonged intubation time (>60 s). The estimated degree of difficulty was not significantly different. CONCLUSION: In conclusion, both video-assisted intubation devices, the video-optical intubation stylet and the angled video intubation laryngoscope, can be considered to be simple and effective tools which facilitate tracheal intubation and which require only brief instruction and training.     

Tracheal surgery in children: an 18-year review of four techniques

Objective: Review the short- and long-term outcomes of a single institution experience in infants with congenital tracheal stenosis, comparing four different operative techniques used from 1982 through 2000. Methods: Hospital and clinic records of 50 infants and children who had surgical repair of congenital tracheal stenosis secondary to complete tracheal rings were reviewed. Age at surgery ranged from 7 days to 72 months (median, 5 months, mean 7.8±12 months). Techniques included pericardial patch tracheoplasty (n=28), tracheal autograft (n=12), tracheal resection (n=8), and slide tracheoplasty (n=2). All procedures were done through a median sternotomy with cardiopulmonary bypass. Seventeen patients had a pulmonary artery sling (35%), and 11 had an intracardiac anomaly (22%). Results: There were three early deaths (6% early mortality), two after pericardial tracheoplasty and one after autograft. There were six late deaths (12% late mortality), five after pericardial tracheoplasty and one after slide tracheoplasty. Length of stay (median) was 60 days (pericardial tracheoplasty), 28 days (autograft), 14 days (resection), and 18 days (slide). Reoperation and/or stent placement was required in seven patients (25%) after pericardial tracheoplasty, in two patients (17%) after autograft, in no patients after resection, and in one patient (50%) after slide tracheoplasty. Conclusions: Our current procedures of choice for infants with congenital tracheal stenosis are resection with end-to-end anastomosis for short-segment stenoses (up to eight rings) and the autograft technique for long-segment stenoses. Associated pulmonary artery sling and intracardiac anomalies should be repaired simultaneously.     

The effect on intraocular pressure of tracheal intubation or laryngeal mask™ insertion during sevoflurane anaesthesia in children without the use of muscle relaxants

BACKGROUND: We studied the effects of sevoflurane on intraocular pressure after induction in children undergoing either tracheal tube (TT) or laryngeal mask airway (LMA) insertion without a muscle relaxant METHODS: The study included 38 children. Anaesthesia was induced (8%) and maintained (3-4%) with sevoflurane in 100% O2. No muscle relaxant was used. A TT was inserted in group I (n=20), and an LMA in group II (n=18). IOPs were measured after induction, insertion of TT or LMA and at 1, 2 and 3 min thereafter. The heart rate, mean arterial pressures were also recorded. RESULTS: Intraocular pressures increased significantly in group I after TT (P < 0.01) and remained high until after 3 min. The pressures were similar in the LMA group at all measurements. CONCLUSION: Sevoflurane does not prevent the increase in IOP after intubation without muscle relaxants. LMA does not increase IOP in children after sevoflurane induction.