GlideScope视频喉镜在困难气道患者气管插管术中的临床应用价值和安全性评估

目的评价GlideScope视频喉镜对困难气道患者进行气管插管术的临床应用价值。方法选择2014年7月至2015年7月在该院就诊的困难气道患者40例,随机分为GlideScope视频喉镜组(研究组)和Macintosh直接喉镜组(对照组),每组各20例。比较两组患者喉部Cormack-Lehane分级、气管首次插管成功率、插管操作时间、插管后损伤,记录麻醉诱导前(T_0)、诱导后(T_1)和插管即刻(T_2)各时间点的心率(HR)、平均动脉压(MAP)和脉搏血氧饱和度(SPO_2)。结果研究组喉部Cormack-Lehane分级高分级者显著低于对照组(P0.05);研究组首次插管成功率明显高于对照组(P0.05);研究组插管时间明显短于对照组(P0.05);研究组无插管后损伤的情况,优于对照组;研究组患者T_2时与T_0时比较,血流动力学指标差异无统计学意义(P0.05)。结论 GlideScope视频喉镜可安全用于困难气道的气管插管,显著降低喉部Cormack-Lehane分级,提高首次插管成功率且缩短插管时间,插管后损伤小,并对循环系统影响轻微,有较高的临床应用价值。     

Surfactant administration without intubation in preterm infants with respiratory distress syndrome – our experiences

Background: Surfactant replacement therapy is crucial in the management of respiratory distress syndrome (RDS) in preterm infants. Classic strategies of surfactant administration required intubation. To reduce the need of intubation and mechanical ventilation (MV), we applied surfactant via a thin endotracheal catheter without intubation.

Patients and methods: We compared 26 preterm infants threatened by RDS treated with surfactant via a thin endotracheal catheter without intubation (studied group – SG) with a retrospective group of preterm infants managed on MV with early surfactant treatment using INtubation SURfactant Extubation (INSURE) method (control group – CG). Study had an approval from the ethics committee (RNN/6/14/KE).

Results: In the SG, 26 preterm infants were treated with one dose of surfactant (Curosurf®) administered via endotracheal catheter without intubation while receiving nasal continuous positive airway pressure (nCPAP)/SiPAP (Infant Flow). After surfactant administration, significantly less patients in SG required intubation and MV (19.2%) versus 65% necessity of second intubation in the CG. The median of time of MV in SG was 5?d versus 3.5?d in CG. Median time spent on nCPAP was 5.5?d versus 4.0?d in CG. The incidence of intraventricular hemorrhage (IVH) in the SG was 53.9%, including 50% with ≥IVH II versus 36.7% (30% ≥IVH II) in CG. The incidence of other complications of prematurity in the SG, such as necrotizing enterocolitis was 11.5% versus 23.3% in CG, the hemodynamically important patent ductus arteriosus was observed in 53.9% in SG versus 45% in CG. Bronchopulmonary dysplasia level in SG was significantly lower (15.4%) than in CG (40%), and the incidence of retinopathy of prematurity in SG was also lower (3.9%) versus 11.7% in MV group.

Conclusion: Surfactant application via a thin endotracheal catheter without intubation seems to be a beneficial therapy for preterm infants with slight and mild degree of RDS. This new method of surfactant application was associated with a lower prevalence of intubation and MV and better pulmonary outcome than implementation of traditional surfactant therapy (INSURE) and MV. Prospective randomized controlled trial is required.     

神经外科重症患者计划拔管失败的相关因素分析

目的:调查分析神经外科重症患者气管插管计划拔管失败的相关影响因素。方法:收集我科重症监护室进行气管插管、带管时间48 h、进行过气管插管拔管操作的患者的临床资料及与拔管结果相关的影响因素,比较拔管成功组与失败组之间因素的差异,分析其危险因素。结果:共收集病例108例,拔管失败19例,成功89例。2组格拉斯哥昏迷量表(GCS)评分、机械通气时间、呼吸浅快指数、咳嗽反射差异有统计学意义(P0.05)。结论:GCS评分、机械通气时间、呼吸浅快指数及咳嗽反射可能是影响气管插管计划拔管成败的重要因素。     

3种气管插管头位上气道CT三维图像的比较分析

 目的  对3种不同头位的上气道CT图像进行三维重建,从经典三轴线理论和气管插管的立体空间两个角度比较分析,为优化气管插管头位提供解剖依据。方法  1例健康女性志愿者在平卧位、后仰位、嗅物位下分别行上气道CT平扫,并三维重建上气道模型。在CT影像上标记口轴(the axis of the mouth,MA)、咽轴(the pharyngeal axis,PA)、喉轴(the laryngeal axis,LA)的轴线位置并测量口-咽轴(M-P)、口-喉轴(M-L)、喉-咽轴(L-P)之间的交角。标记通过寰椎平面的直线(A),通过枕骨下缘平面的直线(O),测量A-O线相交的锐角。根据CT图像重建上气道三维模型,选取口腔和口咽腔区域,计算口腔和口咽腔体积(Vo和Vp)。结果  3种体位下口-咽-喉三轴线交角总和(L-P+M-P+M-L)在平卧位>后仰位>嗅物位;喉-咽轴交角在平卧位≈嗅物位<后仰位;口-咽轴交角在嗅物位<后仰位<平卧位;口-喉轴交角在后仰位<嗅物位<平卧位。A-O角在嗅物位≈后仰位<平卧位。口和口咽腔体积均在平卧位<嗅物位<后仰位,其中嗅物位约为平卧位的1.57倍;后仰位约为平卧位的2倍。结论  嗅物位时口-咽-喉三轴线最接近于重叠,最有利于喉镜显露声门;后仰位时口和口咽腔体积最大,有更多的气管插管操作空间。     

舒芬太尼和右美托咪定在88例患者困难气道盲探插管中的应用研究

目的：探究困难气道患者采取盲探插管时应用舒芬太尼及右美托咪定麻醉的临床效果。方法选取在唐山工人医院治疗且伴有气道困难患者,根据术前镇静药物不同将患者分为治疗组及对照组,每组44例。治疗组患者采用右美托咪定进行麻醉处理,对照组采用舒芬太尼进行麻醉处理,后行盲探气管插管术。分别于麻醉前、麻醉诱导完成后、插管到达悬雍垂时、插管到达会厌时、插管完成时及插管完成后5min检测患者的心率、动脉收缩压、动脉舒张压及呼吸频率,以及患者在插管过程中出现恶心、躁动、呛咳及呼吸抑制的例数。结果从麻醉诱导后直至插管完成后5min治疗组患者的呼吸频率高于对照组（P＜0．05）;自导管到达患者悬雍垂时直至插管完成时治疗组患者的动脉收缩压、动脉舒张压及心率明显低于对照组（P＜0．05）;治疗组插管后5min动脉血氧分压为（98．52±9．18）mmHg,明显高于对照组插管后5min动脉血氧分压[（93．46±10．81）mmHg]（P＜0．05）;治疗组患者插管过程中出现恶心、躁动、呛咳、呼吸抑制例数明显低于对照组（P＜0．05）,治疗组患者平均插管时间明显低于对照组（P＜0．05）。结论右美托咪定可有效改善困难气道患者的气道状况,达到有效的麻醉效果,降低患者心肺反应性,保证了困难气道患者插管过程的顺利进行。     

ICU经口气管插管口腔护理研究现状（综述）

ICU病房经口气管插管患者多,气管插管患者的口腔护理也就成了难题。该文比较了各种不同的口腔护理方法,并且主张根据患者的不同病情选择不同的方法,从而达到提高口腔护理质量、降低VAP发生率的目的。     

基于机器视觉的气管插管圆弧半径测量方法研究

对于圆心角小于30o的圆弧半径测量难度大,现有方法测量效率低、误差大.通过设计机器视觉系统,研究图像检测方法对气管插管圆弧半径的测量,测量结果满意,实现了对圆弧半径快速、准确的测量,拓展了机器视觉的应用领域.     

纤维支气管镜引导左侧双腔支气管导管插管对应激反应的影响

目的比较直视喉镜和纤维支气管镜引导左侧双腔支气管插管对患者应激反应的影响。方法选择ASAⅠ或Ⅱ级开胸手术患者80例,年龄在28～75岁,随机均分成纤支镜组（F组）和直接喉镜组（M组）,每组40例,记录置管时间、定位时间及总插管时间。观察插管前1min、插管后1、3、10min的HR、MAP、血浆去甲肾上腺素（NE）和肾上腺素（E）的变化。结果 M组置管时间明显少于F组,定位时间、总插管时间明显长于F组（P〈0.01）。与插管前1min比较,插管后1、3min两组HR明显增快、MAP明显升高（P〈0.05）;血浆NE、E水平显著升高（P〈0.05）。M组插管后1、3minNE、E水平显著高于F组（P〈0.05）。结论与直接喉镜相比,纤维支气管镜引导左侧双腔管插管定位准确,耗时较少,且对患者应激反应较弱。     

Comparaison de sérum salé, d’air et d’un mélange oxygène–protoxyde d’azote pour le remplissage des ballonnets de sondes d’intubation chez l’enfant ? Étude prospective randomisée

Objective

The purpose of the present study was to compare how many inflate and deflate are necessary to maintain the endotracheal tube cuff pressure between 15 and 35 cm H₂O by using air, O₂–N₂O mix or saline solution.

Study design

Randomized and prospective study.

Patients and methods

Ninety children from 1 month to 15 years of age were included in the study. All patients were ventilated with O₂50%–N₂O50%. Subsequently, the patients were divided in three groups: (1) Group 1: patients with air inflated cuffs; (2) Group 2: patients with O₂–N₂O mix inflated cuffs; (3) Group 3: patients with saline solution inflated cuffs. In all groups cuffs were inflated to reach an intracuff pressure of 20 cmH₂O. The cuff pressure was then monitored every 10 minutes and adjusted to be between 15 and 35 cmH₂O. Laryngeal and tracheal symptoms were noted in the recovery room.

Results

The three groups of patients were similar for age, weight, and sex. The length of surgery was significantly longer in Group 3. The deflate rate was higher in Group 1 (60%) than in Group 2 (10%) or 3 (3.3%) (p < 0.0001). The inflate rate was higher in Group 2 (76.6%) than in Group 1 or 3 (both 3.3%) (p < 0.0001). Side effects were comparable in the three groups of patients.

Conclusion

Using air or O₂–N₂O mix to inflate cuffs is not reliable. SSI helps to maintain a more stable cuff pressure but monitoring is difficult and sometimes contraindicated by tracheal tubes producers. Inflating cuffs with air and regularly monitoring pressure is the most reliable and easiest technique.