预见性气管插管抢救重度有机磷农药中毒合并呼吸不全研究

目的：探讨在重度有机磷农药中毒合并呼吸不全患者中实施预见性气管插管的方法及效果。方法：对2011年10月-2013年10月本院抢救的70例重度有机磷农药中毒合并呼吸不全患者进行随机数字表法分组,每组35例,两组均给予常规基础治疗,在此基础上,对照组（非气管插管组）实施血液灌流,观察组实施血液灌流及预见性气管插管,分析并评估两组病例的临床抢救情况。结果：观察组抢救成功率与病死率分别为94.29%、5.71%,明显优于对照组的74.29%、25.71%,两组比较差异有统计学意义（P〈0.05）;观察组在复能剂用量、昏迷时间及住院时间等方面要更具优越性,差异均有统计学意义（P〈0.05）。另外,两组治疗期间均有严重不适症状发生,两组比较差异无统计学意义（P〉0.05）。结论：在重度有机磷农药中毒合并呼吸不全患者中实施预见性气管插管进行抢救有确切效果,适合在今后的临床上普及应用。     

复方利多卡因乳膏用于脑动脉瘤夹闭术麻醉预防心血管应激反应研究

目的观察复方利多卡因乳膏用于脑动脉瘤夹闭术全麻插管患者,旨在评价对抑制气管导管刺激引起的心血管应激反应的效果。方法选择40例急、慢诊脑动脉瘤夹闭术患者,ASA为Ⅱ~Ⅳ级,拟施全麻气管插管行动脉瘤夹闭术,并随机分为两组,每组20例。对照组(I组),不使用复方利多卡因乳膏涂抹气管导管,实验组(II组),将复方利多卡因乳膏均匀涂抹气管导管套囊及前端,麻醉诱导后行气管内插管。分别记录患者在麻醉前、插管前、插管时、变动体位、抬头消毒和拔管时平均动脉压(MAP)和心率(HR)。结果插管时与插管前,I组患者明显出现一过性MAP升高和HR增快。而II组插管刺激反应弱于I组。组间与同时刻比较,差异有统计学意义(P0.05)。在变动体位和抬头消毒时与插管前I组仍出现MAP升高和HR增快现象。而II组却无明显变化,组间与同时刻比较,差异有统计学意义(P0.05)。在拔管时与插管前,I组患者明显出现MAP升高和HR增快现象,而II组却弱于I组,组间与同时刻比较,差异有统计学意义(P0.05)。结论将复方利多卡因乳膏均匀涂抹气管导管用于脑动脉瘤夹闭术全麻插管患者,可以有效抑制气管导管刺激引起的心血管应激反应。     

气管内插管全麻患者术后咽喉部并发症研究进展

全麻手术中采用气管内插管常常造成咽喉部的创伤和病变,并导致咽喉部术后并发症的产生,如咽喉炎、声嘶和吞咽困难等。本文针对气管内插管的全麻患者术后咽喉部并发症的发生原因及其主要干预措施进行综述,为临床治疗及护理此类患者,提高患者舒适度提供理论依据。     

早期气道状况评估对急诊科危重症患者救治的影响

目的探讨早期气道评估对急诊科危重症患者救治的影响。方法将166例行气管插管的危重症患者按是否行早期气道评估分为早期评估组（86例）和对照组（80例）,对照组患者因病情变化需要建立人工气道时,由值班医生进行首次气管插管,并在插管前采用喉镜观察分级评估气道;早期评估组患者入急诊科时即由值班医生采用改良的Mallampati分级及甲颏距离测量进行早期气道评估。记录两组首次气管插管成功例数、气管插管时间、预估为困难气道的例数、预估为困难气道首次插管成功的例数、气管插管失败需行紧急气管造口的例数、生命体征相对稳定达转送的间隔时间、急诊科内死亡例数。结果两组气管插管时间、预估为困难气道率、气管插管失败需要行紧急气管造口置管率比较差异均无统计学意义（p〉0．05）;早期评估组首次气管插管成功率和预估为困难气道首次插管成功率均明显高于对照组[69．4％（59／85）比40．0％（32,80）、80．0％（28／35）比32．3％（10／31）],生命体征相对稳定达转送的间隔时间明显短于对照组[（89．5±23．2）min比（110．4±48．2）min],急诊科内病死率明显低于对照组[8．2％（7／85）比18．8％（15,80）],差异均有统计学意义（P〈0．05）。结论在急诊科早期对患者进行气道评估并做好相应的准备工作有利于提高急诊困难气道患者的首次气管插管成功率,有助于患者病情稳定,及早达到安全转送的标准。     

Use of the GlideScope does not lower the hemodynamic response to tracheal intubation more than the Macintosh laryngoscope: a systematic review and meta-analysis

Background:It is presently unclear whether the hemodynamic response to intubation is less marked with indirect laryngoscopy using the GlideScope (GlideScope) than with direct laryngoscopy using the Macintosh laryngoscope. Thus, the aim of this study was to determine whether using the GlideScope lowers the hemodynamic response to tracheal intubation more than using the Macintosh laryngoscope.Methods:We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim was to determine whether the heart rate (HR) and mean blood pressure (MBP) 60 s after tracheal intubation with the GlideScope were lower than after intubation with the Macintosh laryngoscope. We expressed pooled differences in HR and MBP between the devices as the weighted mean difference with 95% confidence interval and also performed trial sequential analysis (TSA). Second, we examined whether use of the GlideScope resulted in lower post-intubation hemodynamic responses at 120, 180, and 300 s compared with use of the Macintosh laryngoscope. For sensitivity analysis, we used a multivariate random effects model that accounted for within-study correlation of the longitudinal data.Results:The literature search identified 13 articles. HR and MBP at 60 seconds post-intubation was not significantly lower with the GlideScope than with the Macintosh (HR vs MBP: weighted mean difference = 0.22 vs 2.56; 95% confidence interval −3.43 to 3.88 vs −0.82 to 5.93; P = .90 vs 0.14; I² = 77% vs 63%: Cochran Q, 52.7 vs 27.2). Use of the GlideScope was not associated with a significantly lower HR or MBP at 120, 180, or 300 s post-intubation. TSA indicated that the total sample size was over the futility boundary for HR and MBP. Sensitivity analysis indicated no significant association between use of the GlideScope and a lower HR or MBP at any measurement point.Conclusions:Compared with the Macintosh laryngoscope, the GlideScope did not lower the hemodynamic response after tracheal intubation. Sensitivity analysis results supported this finding, and the results of TSA suggest that the total sample size exceeded the TSA monitoring boundary for HR and MBP.     

Emergency thyroidectomy: Due to acute respiratory failure

INTRODUCTION

Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention.

PRESENTATION OF CASE

A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cervical swelling progressively increased during the last 7 years and constituted severe respiratory failure which has become severe in the last one month. A giant nodular goiter of the left thyroid lobe extending retrosternally, causing tracheal compression, limiting the neck movements was detected with clinical examination and bedside ultrasound. Emergency thyroidectomy was planned. Fiberoptic-assisted awake nasal intubation was performed in the operating room. Emergency total thyroidectomy was performed for the life-threatening respiratory failure. Postoperative period was uneventful. She was transferred from intensive care unit to the ward on postoperative day 3 and was discharged from the hospital on the postoperative 7th day. Benign multinodular hyperplasia was reported on the histopathological report. Patient was included in routine follow-up.

DISCUSSION

In the present case tracheal destruction due to compression of the giant goiter was found in agreement with previous reports. Emergency thyroidectomy was performed after awake intubation since it is a common surgical option for the treatment of giant goiter causing severe airway obstruction.

CONCLUSION

Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.     

超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜在肥胖患者清醒气管插管中的应用效果

目的 探讨超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜在肥胖患者清醒气管插管中的应用效果。方法 选择2018年1月－2020年1月该院收治的120例拟行气管插管全身麻醉的肥胖患者作为研究对象,使用随机数表法将患者分为两组,每组各60例。观察组采用超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜气管插管,对照组采用超声引导下喉上神经阻滞联合传统光学喉镜气管插管。观察两组患者声门显露成功率、一次性气管插管成功率、总插管成功率、成功插管的平均插管时间、插管过程中呛咳发生率以及呛咳程度、血流动力学和插管相关并发症发生情况。结果 观察组声门显露成功率、一次性气管插管成功率高于对照组（P < 0.05）,成功插管的平均插管时间短于对照组（P < 0.05）,插管后1 min（T₁）和5 min（T₂）患者心率（HR）、无创收缩压（SBP）和无创舒张压（DBP）低于对照组（P < 0.05）,经皮动脉血氧饱和度（SpO₂）高于对照组（P < 0.05）,口腔出血、咽喉部损伤和气道损伤等并发症总发生率低于对照组（P < 0.05）。结论 超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜气管插管,可提高肥胖患者声门显露成功率和一次性插管成功率,缓解血流动力学波动,减少插管相关并发症发生风险。     

右美托咪定与芬太尼类药物在清醒气管插管患者麻醉诱导效果比较的Meta分析

目的采用Meta分析比较右美托咪定与芬太尼类药物在清醒气管插管患者中麻醉诱导的效果。方法检索Cochrane图书馆、PubMed、Embase、中国生物医学文献数据库(CBM)、CNKI、维普、万方数据库,检索时间从1990年至2014年2月。收集清醒气管插管患者使用右美托咪定与常用芬太尼类药物(芬太尼、舒芬太尼、瑞芬太尼)作为麻醉诱导的临床随机对照研究(RCT)。采用Cochrane协作网系统评价法评价纳入文献的质量,采用RevMan 5.0软件对收集的患者资料进行Meta分析评价。结果纳入10篇研究400例患者,其中右美托咪定组197例,芬太尼类药物组203例。在插管前即刻右美托咪定组患者的镇静效果(RSS评分)明显优于芬太尼类药物组(WMD1.29,95%CI 1.02~1.56),插管完成即刻右美托咪定组的镇静效果(RSS评分)同样优于芬太尼类药物组(WMD 1.41,95%CI 1.10~1.72)。右美托咪定组呛咳反射发生率明显低于芬太尼类药物组(OR 0.10,95%CI为0.03~0.31)。右美托咪定组高血压发生率明显低于芬太尼类药物组(OR0.25,95%CI 0.11~0.57)。右美托咪定组呼吸抑制发生率明显低于芬太尼类药物组(OR 0.33,95%CI 0.16~0.72)。右美托咪定组术后不良记忆发生率明显低于芬太尼类药物组(OR 0.50,95%CI 0.28~0.92)。结论与芬太尼类药物比较,右美托咪定用于清醒气管插管更具有优势。