改良逆行气管插管技术在颈椎骨折手术麻醉中的应用

目的评估改良逆行气管插管术在颈椎骨折手术麻醉中的应用效果。方法拟全麻下行颈椎减压融合术的颈椎骨折患者32例，ASAⅠ～Ⅲ级，其中C2或C2～3骨折19例，C3-4骨折6例，C6-7，骨折7例，伴脊髓损伤不全瘫7例，伴肋骨骨折、颧弓骨折2例。患者均采用改良逆行气管插管术完成气管插管。记录麻醉插管各时间段患者的心率、血压及血氧饱和度、气管插管所需时间、首次插管成功率、气管插管相关的不良反应和并发症发生情况。结果32例患者均用此气管插管术成功插入气管导管，且首次插管成功率为100％。气管插管所用的平均时间为（162±12）s。患者气管插管时的心率、血压值较诱导前无显著差异（P〉0．05），血氧饱和度保持在95％以上。术后随访无不良反应和并发症发生。结论改良逆行气管插管术操作简单易行，成功率高，不加重患者脊髓损伤，可广泛应用于颈椎骨折手术麻醉。

Application of the improved retrograde tracheal intubation in the anaesthesia for patients undergoing cervical spine fracture surgery

Objective To evaluate the application of the improved retrograde endotracheal intubation technique in the anaesthesia for patients undergoing cervical spine surgery. Methods A total of 32 patients （ ASA score I -III ） who received cervical spine decompression and fusion surgeries under general anesthesia were included in this study. Among them, 19 patients were with C2 or C2-3 fracture, 6 with C3-4 fracture, 7 with C6-7 fracture. Yet 7 patients were accompanied with spinal cord injury and incomplete paralysis, and 2 with zygomatic arch fracture. The improved retrograde endotracheal intubation technique which used retrograde wire and forward airway exchange catheter for guiding. Data of heart rate, blood pressure and SPO2 in the procedure of intubation were recorded. The time that endotracheal intubation needed, the success rate of the first attempt, and the adverse effect or complications related to endotracheal intubation were fully documented. Results This improved endotracheal intubation technique was successfully accomplished in all 32 patients, and the success rate of the first attempt was 100%. The time that endotracheal intubation needed was （ 162 ± 12 ） s. The patients＇ heart rate and blood pressure had no significant variation during endotracheal intubation compared to pre-induction （ P 〉 0.05 ） and SPO2 lasted over 95 % during endotracheal intubation.No adverse effect and complications caused by tracheal intubation were found after operation. Conclusion The improved retrograde endotracheal intubation, which is easy to perform, can avoid secondary spinal cord injury in the patients with cervical spine fracture during endotracheal intubation procedure, and the success rate is high. It can be widely applied in the anaesthesia for patients undergoing cervical spine fracture surgeries.