Objective:To assess the feasibility of sedation via awake blind nasal tracheal intubation by partial pressure of end-tidal carbon dioxide (PETCO2) monitoring for patients with ankylosing spondylitis that leads to difficult airway intubation. Methods:Thirty ASA Ⅱ patients of ankylosing spondylitis(20 males,10 females; aged 40 ～ 80 years; weighing 55 ～ 70 kg)undergoing general anesthesia were randomized into groups of blind nasal intubation (group B, n = 15 ) and fiberoptic bronchoscope guidance( FOB, n = 15 ). All patients, who fell into grade Ⅲ ～ Ⅳ as the classification of difficulty in intubation defined by Cormack and Lehane,with mouth opening less than 2 cm, were undergone awake nasal tracheal intubation, and the two groups of patient were kept concerning the respective changes of mean arterial blood pressure( MAP), heart rate(HR) and SpO2 right after the intubation (To ), at 1 min ( T1 ), 5 min( T2 ), 10 min(T3 ) and the moment of extubation( T4 ) besides duration of intubation, succossful rate and complications. Results: Intubation was performed successfully in the total 30 patients. Nevertheless, group B consumed longer time in intubation than did of group FOB ( P ＜ 0.05 ), and significant differences of the two groups was found regarding the variation of MAP and HR at T1 ,T2 ,T3, T4 as compared with T0 ( P ＜ 0. 05 ). There was no significant difference concerning the rate of successful intubation and complications. Conclusion: Sedation via awake blind nasal tracheal intubation by partial pressure of end-tidal carbon dioxide( PETCO2 ) monitoring is safe and reliable for patients with difficult airway intubation due to ankylosing spondylitis.%目的:探讨以呼气末二氧化碳(PETCO2)监测引导下经鼻盲探气管插管用于强直性脊柱炎困难气道患者的可行性.方法:强直性脊柱炎拟行全麻患者30例,ASAⅡ级,男20例,女10例,年龄40 ～80岁,体重55 ～70 kg,张口度<2 cm,Cormack-Lehane分级Ⅲ或Ⅳ级,随机分为两组(n=15):盲探组(B组)与纤维支气管镜引导组(FOB组),行清醒经鼻气管插管.于气管插管后即刻(T0)、气管插管后1 min(T1)、5 min(T2)、10 min(T3)和拔管时(T4)分别记录两组的平均动脉压、心率、脉搏血氧饱和度,记录气管插管完成时间、成功率及并发症的发生情况.结果:30例患者均完成气管插管.与FOB组比较,B组气管插管时间延长(P<0.05);与T0时比较,两组在T1、T2 、T3、T4时平均动脉压和心率有显著性差异(P<0.05);气管插管成功率及并发症的差异无统计学意义(P>0.05).结论:以呼气末二氧化碳引导下镇静复合少量局麻药清醒经鼻盲探气管插管用于强直性脊柱炎困难气道患者是可行的.
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