头位对清醒状态下经纤维支气管镜经口气管插管效果的影响：一项随机对照试验。

Effects of head positions on awake fiberoptic bronchoscope oral intubation: a randomized controlled trial.

机构信息

Department of Anesthesiology, the First hospital of Qinhuangdao, N.O. 258, Wenhua Road, Qinhuangdao, Hebei, China.

Department of thoracic surgery, the First hospital of Qinhuangdao, N.O. 258, Wenhua Road, Qinhuangdao, Hebei, China.

出版信息

BMC Anesthesiol. 2021 Jun 23;21(1):176. doi: 10.1186/s12871-021-01397-4.

DOI:10.1186/s12871-021-01397-4

PMID:34162330

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8220748/

Abstract

BACKGROUND

There are many factors affecting the success rate of awake orotracheal intubation via fiberoptic bronchoscope. We performed this study was to investigate the effects of head positions on awake Fiberoptic bronchoscope oral intubation.

METHODS

Seventy-five adult patients, received general anaesthesia were included in this study. After written informed consent, these patients were undergoing awake orotracheal intubation via fiberoptic-bronchoscope and according to the head position, the patients were randomized allocated to neutral position group (NP group), sniffing position group (SP group) or extension position group (EP group). After sedation the patients were intubated by an experienced anesthesiologist. The time to view the vocal cords, the percentage of glottic opening scores (POGO), the time to insert the tracheal tube into trachea and the visual analog scale (VAS) scores for ease experienced of passing the tracheal tube through glottis, the hemodynamic changes and the adverse events after surgery were recorded.

RESULTS

The time to view the vocal cords was significantly shorter and the POGO scores was significantly higher in the EP group compared with the other two groups (P < 0.05); The SpO in the EP group was higher than NP group at before intubation and higher than SP group and NP group at immediate after intubation (P < 0.05); The time to insert the tracheal tube into trachea, the VAS scores for passing the tracheal tube through glottis, the coughing scores had no significant differences among groups (P > 0.05). There were also no significant differences regard to the incidence of postoperative complications, mean arterial pressure and heart rate among the groups (P > 0.05).

CONCLUSIONS

The head at extension position had a best view of glottic opening than neutral position or sniffing position during awake Fiberoptic bronchoscope oral intubation, so extension position was recommended as the starting head position for awake Fiberoptic bronchoscope oral intubation.

TRIAL REGISTRATION

Clinical Trials.gov. no. NCT02792855. Registered at https://register.clinicaltrials.gov on 23 september 2017.

摘要

背景

影响纤维支气管镜经口清醒气管插管成功率的因素很多。我们进行这项研究是为了探讨头位对纤维支气管镜经口清醒插管的影响。

方法

本研究纳入 75 例接受全身麻醉的成年患者。在书面知情同意后，这些患者接受纤维支气管镜经口清醒气管插管，并根据头位将患者随机分配至中立位组（NP 组）、嗅探位组（SP 组）或伸展位组（EP 组）。镇静后，由经验丰富的麻醉医师进行插管。记录观察声带的时间、声门开放评分（POGO）百分比、将气管导管插入气管的时间以及通过声门时的视觉模拟评分（VAS）、通过声门时的血流动力学变化和术后不良反应。

结果

与其他两组相比，EP 组观察声带的时间明显缩短，POGO 评分明显升高（P<0.05）；EP 组在插管前的 SpO2 高于 NP 组，在插管即刻的 SpO2 高于 SP 组和 NP 组（P<0.05）；将气管导管插入气管的时间、通过声门时的 VAS 评分、咳嗽评分在各组之间无显著差异（P>0.05）。各组术后并发症发生率、平均动脉压和心率也无显著差异（P>0.05）。