七氟醚吸入诱导后纤支镜引导下经鼻气管插管

目的探讨七氟醚吸入诱导后纤支镜引导下经鼻气管插管，用于困难气道处理的安全性和可行性。方法18例术前评估为插管困难手术患者，需减少插管过程中颈部活动，采用七氟醚吸入诱导后纤支镜引导下经鼻气管插管，观察诱导插管过程中有无气道并发症（如窒息、咳嗽和喉痉挛），术后随访患者有无知晓。比较16例一次性插入气管导管患者，诱导和插管前后MAP、HR、BIS值的变化。结果16例患者一次性顺利经鼻插管成功。另有2例插管不顺利，二次经鼻插管成功。术后回访，18例患者对诱导插管过程均无记忆。BIS值在T1～T4于诱导前T0（P〈0．05）；诱导后（T1、T2）HR和MAP较诱导前T0有降低，但无统计学意义；插管后1min（T3）时点HR较诱导前升高，（P〈0．05），而MAP升高无统计学意义；HR和MAP在插管后1min（T3）均高于插管前B（P〈0．05）。结论七氟醚吸入诱导后纤支镜引导下经鼻气管插管，用于困难气道的处理，效果良好，有临床实用性，但不能完全避免插管反应。插管成功的关键还有赖于丰富的经验、熟练的操作、充分的准备。

Application of inhaled induction with sevoflurane and nasotracheal intubation guided by bronchofibroscopc

Objective To evaluate application of inhaled induction with sevoflurane and nasotracheal intubation guided by bronchofibroscope in management of the difficult airway. Methods 18 cases of patients who have difficulty to intubation, sevoflurane inhaled induction was used and nasotracheal intubation guided by bronchofibroscope. The complication( apnea,cough and laryngospasm)during induction was observed. To compare the clinic datas of MAP, HR and BIS during induction and intuba-tion in 16 cases who were successfully intubated at the first try. Results 16 cases were successfully intubated within one time. 2 cases need double chances. There are no awareness during induction in 18 cases. All BIS were decreased significantly after inhaled induction(P<0.05). After 1 min of intubation, HR were siguificantly increased compared with the rates before induction(P<0.05), but MAP were no significant difference. After intubation, HR and MAP were significandy increased (P<0.05). Conclu-sion Application of inhaled induction with sevoflurane and nasotracheal intubation guided by bronchofibroscope is a safe and i-deal anaesthesia technique in management of the difficult airway. It should be finished by experienced doctor.