头部位置对经口纤维支气管镜清醒插管的影响:一项随机对照试验

头部位置对经口纤维支气管镜清醒插管的影响:一项随机对照试验

贵州医科大学 高鸿教授课题组

翻译：张中伟  编辑：佟睿  审校：曹莹

背景

影响纤维支气管镜清醒气管插管成功率的因素有很多。本试验目的为研究头部位置对经口纤维支气管镜清醒插管的影响。

方法

本研究纳入接受全身麻醉的75名成年患者。获得患者书面知情同意后，这些患者行纤维支气管镜下经口清醒气管插管，并根据头部位置，将患者随机分为中立位组(NP组)、嗅物位组(SP组)和头伸位组(EP组)。接受镇静治疗后，患者由一名经验丰富的麻醉医生进行插管。记录从操作开始直至可查看到声门的时间、声门开口评分(POGO)的百分比、将气管导管插入气管的时间以及气管导管穿过声门的难易程度的视觉模拟评分(VAS)、插管引起的血流动力学变化和手术后并发症的发生率。

结果

头伸位组(EP组)查看到声门的时间明显短于其他两组，POGO评分明显高于其他两组(P<0.05)；头伸位组插管前血氧饱和度高于中立位组(NP组)，插管后即刻血氧饱和度高于中立位组(NP组)和嗅物位组(SP组)(P<0.05)；各组间气管导管插入气管的时间、气管导管通过声门时的视觉模拟评分、咳嗽评分无显著差异(P>0.05)。各组间术后并发症发生率、平均动脉压和心率也无显著差异(P>0.05)。

结论

清醒状态下使用纤维支气管镜经口气管插管时，头伸位比中立位和嗅物位更能迅速查看到声门开口，因此建议将头伸位作为清醒状态下纤维支气管镜经口插管的起始头位。

原始文献来源：

Zhuo Liu, Li Zhao, Zhongfeng Ma，et al. Effects of head positions on awake fiberoptic bronchoscope oral intubation: a randomized controlled trial.[J].BMC Anesthesiology (2021) 21:176 :1

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Effects of head positions on awake

fiberoptic bronchoscope oral intubation: a randomized controlled trial

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 SpO2in 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.