目的：观察套囊充气法辅助纤维支气管镜（FOB）引导下经鼻清醒气管内插管的临床效果，并与传统的FOB插管方法进行比较。方法40例存在困难气道的手术患者，年龄21~73岁，ASAI~III级，随机数字表法分为两组（每组20例）：观察组（A组）和对照组（B组）。A组：先将气管导管插入鼻腔至咽喉部后，再将套囊充气使导管前端翘起，然后将FOB镜体穿过气管导管见到声门后将FOB前端置入气管内，此时抽掉导管套囊内气体，顺镜管将导管送入气管内；B组：将套有气管导管的FOB镜体经一侧鼻腔插入后寻找声门，将FOB前端插入气管，顺镜管将导管送入气管内。记录两组插管时间、一次性插管成功情况、患者对插管过程满意度评分、插管过程心血管反应和不良反应发生情况。结果与B组比较，A组气管插管时间明显缩短，一次气管插管成功率提高，术后满意度评分升高（P<0.05），两组患者在插管过程中血流动力学的变化比较差异无统计学意义（P>0.05），不良反应发生率无明显差异。结论套囊充气法辅助FOB引导下清醒经鼻气管插管，与传统FOB引导经鼻插管比较，插管时间更短，一次性插管成功率更高，患者满意度评分高，是临床上值得推广的FOB插管方法。%ObjectiveTo observe the efficacy of fiberoptic bronchoscope(FOB)-guided nasal intubation with cuff inflation,and compare itwith the traditional FOB intubation method.Methods 40 ASAⅠorⅢ aged 21-73 yr patients with difficult airway undergoing awake nasal intubation assisted by FOB were randomly divided into 2 groups(20 cases in each group):the observation group(group A)and control group(group B). In group A:Through the nasal cavity,insert the endtracheal tube to the throat,and fill up the gas capsule to raise the front of tube,the glottis can be seen when the FOB pass through the trachea,and suck out the gas in the capsule,then insert the catheter to the trachea along the FOB. In group B:Put the FOB into the endotracheal tube,then passing the throat insert them together to the glottis. Put the front end of the FOB into trachea,then insert the catheter to the trachea along the FOB.The intubation time,rate of the first successful intubation,Patients satisfaction scores,intubation in patients with cardiovascular response and adverse reactions occur were recored.Results The intubation time was significantly shorter and the rate of successful intubation at first attempt was higher in group A than in group B(P<0.05).Patients satisfaction scores were significantly higher in group A than in group B(P<0.05).Two groups of patients in the process of intubation hemodynamic changes comparing with no statistical significance. No difference between the incidences of adverse reactions.Conclusion Comparing with the traditional FOB intubation method,FOB-guided nasal intubation with cuff inflation can shorten the intubation time,improve the success rate of first attempt and patient satisfaction scores. This method is worthy of clinical promotion.
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