内镜面罩辅助通气在纤维支气管镜气管内插管中的应用

目的观察内镜面罩辅助通气在纤维支气管镜气管内插管中运用的优点和可行性。方法 2009年6月-12月须行择期手术经口/鼻气管内插管的病人20例,ASAI-Ⅱ级,插管前鼻腔和口咽部行1%丁卡因表面麻醉,静脉推注芬太尼0.1mg,缓慢推注异丙酚2mg/kg,待病人意识消失后,通过内镜面罩的镜口插入套有气管导管的纤维支气管镜进行气管内插管,插管过程中使用内镜面罩进行辅助正压通气。观察患者呼吸循环参数、插管时间、成功率、相关并发症及纤维支气管镜图像的清晰程度和寻找会厌、声门等解剖学标志的难易程度。结果所有病例中,内镜面罩均能有效地进行辅助正压通气。插管过程中循环稳定,脉搏氧饱和度（SpO2）能维持在98%以上。插管时间为2.6min（0.8-5.3min）,一次插管成功率为80%,二次插管成功率为20%。纤维支气管镜成像效果清楚的达60%,中等的达25%,模糊的达15%;经纤维支气管镜能见到会厌的达30%,能见到会厌和声门的达25%,能见到声门的达35%,未见会厌和声门的达10%（由于成像模糊）。结论在使用纤维支气管镜进行气管插管的过程中,使用内镜面罩行辅助正压通气,可保持病人在插管过程中的充分给氧,增加了一次插管的成功率。由于可对病人进行深度镇静,增加了病人的舒适性。另外,由于提供了充分的插管时间,可清楚地观察插管的过程及会厌和声门等解剖学标志,还可通过外接电视很好地用于示教和教学。

Assisted ventilation with endoscopy mask during fiberoptic bronchoscopic endotracheal intubation

Objective To evaluate efficacy and safety of assisted ventilation with endoscopy mask during fiberopfic bronchoscopic endotracheal intubation.Methods 20 patients for general anesthesia with endotracheal intubation through mouth or nose were administered slowly with propofol 2mg/kg after fentanyl 0.1mg intravenously. Endotracheal intubation was performed under fiberoptic bronchoscopy through an endoscopy mask. Assisted positive pressure ventilation was used during procedure. The patients＇ BP,HR,SpO2,intubation time,success ratio,complication and image clearness of bronchofibroscope,easiness for searching anatomy marks of epiglottis and glottic were recorded.Results All cases could be ventilated successfully with endoscopy mask. Hemodynamic,pulse oxygen saturation were not altered during procedure. Intubation time was 2.6min （0.8-5.3 min）. The ratio of one successful tracheal intubation was 80% and second intubafion successful ratio was 30%.Conclusion During fiberoptic intubation,assisted ventilation with endoscopy mask can oxygen the patients fully and improve the ratio of one timed successful intubation. It makes patients feel comfortable by deep sedation. In addition,it supplies sufficient time for intubation and can be used for teaching and demonstration by clearly observing the endotracheal intubation process,anatomic markers of epiglottis and glottis.