气管插管：经鼻气管插管选择左鼻孔还是右鼻孔？

本文由“小麻哥的日常"授权转载

摘要译文（供参考）

使用视频刚性管芯时鼻孔选择对经鼻气管插管的影响：

一项随机临床试验

背景：

在全身麻醉下进行口腔颌面外科手术的患者通常需要鼻气管插管。

当患者鼻孔同样通畅时，选择用于插管的鼻孔是促进插管的重要决定。

本试验的目的是确定在接受口腔颌面外科手术的患者中使用视频刚性管芯时，鼻孔的选择是否会影响鼻气管插管。

方法：

将50例择期口腔颌面外科患者随机分为两组，分别通过左鼻孔（L组，n=25）和右鼻孔（R组，n=5）进行经鼻气管插管。

经验丰富的麻醉医师使用视频刚性管芯进行插管。

主要结局指标是成功插管的时间，该时间定义为从管芯组件的尖端进入所选鼻孔到气管导管进入气管的持续时间。

次要结局指标包括：

器械插入时间长度；

插入导管的时间长度；

总成功率；

首次尝试成功率；

插管尝试次数；

气道辅助动作的要求；

鼻出血的发生率和严重程度。

术后24小时内监测插管相关不良事件。

结果：

L组气管插管的中位时间（四分位间距）为25.3秒（20.7至27.6），R组为26.8秒（22.5至30.0）（中位差（MD）=1.9；

95%置信区间（CI）-1.8至5.7，P=0.248）。

两组中所有患者的经鼻气管插管均成功，两组的首次尝试成功率相似（L组：

96%（24/25）；

R组：

96%（24/25）；

相对风险（RR）1.0；

95%可信区间0.9至1.1；

P＞0.999）。

两组对辅助动作的需求无显著差异（L组：

36%（9/25）；

R组：

28%（7/25）；

RR 0.8；

95%置信区间0.3-1.8；

P＝0.544）。

此外，所有患者都表现出高质量的声门可视化分级（Cormack和Lehane I级）。

就安全性而言，两组插管期间鼻出血的发生率和严重程度相当。手术后24小时内，鼻孔的选择和插管相关不良事件之间没有显著差异。

结论：

当考虑使用视频刚性管芯插管时，任何一个鼻孔都可以使用。

原文摘要 Impact of choice of nostril on nasotracheal intubation when using video rigid stylet: a randomized clinical trial Background: Patients undergoing oral and maxillofacial surgeries under general anesthesia usually require nasotracheal intubation. When presented with patients with equally patent nostrils, selection of the nostril to use for intubation is an important decision for facilitating intubation. The objective of this trial is to determine whether choice of nostril impacts nasotracheal intubation when using a video rigid stylet in patients undergoing oral and maxillofacial surgery. Methods: Fifty patients scheduled for elective oral and maxillofacial surgery requiring nasotracheal intubation were randomly allocated into two groups to undergo nasotracheal intubation through the left nostril (Group L, n = 25) or the right nostril (Group R, n = 25). Intubation was performed by experienced anesthesiologists using a video rigid stylet. The primary endpoint was time to successful intubation, which was defined as the duration from when the tip of the stylet-tube assembly entered the selected nostril to when the tube entered the trachea. Secondary outcomes included: length of time for device insertion; length of time for tube insertion; total success rate; first-attempt success rate; number of intubation attempts; requirement of airway assisted maneuvers; incidence and severity of epistaxis. Intubation-related adverse events were monitored for up to postoperative 24 h. Results: Median time (interquartile range) to tracheal intubation was 25.3 seconds (20.7 to 27.6) in Group L and 26.8 seconds (22.5 to 30.0) in Group R (median difference (MD) = 1.9; 95% confidence interval (CI) -1.8 to 5.7, P = 0.248). Nasotracheal intubation was successful in all patients in both groups and the first-attempt success rates in both groups were similar (Group L: 96% (24/25); Group R: 96% (24/25); relative risk (RR) 1.0; 95% CI 0.9 to 1.1; P > 0.999). No significant difference of requirement of assisted maneuvers was noted between the two groups (Group L: 36% (9/25); Group R: 28% (7/25); RR 0.8; 95% CI 0.3-1.8; P = 0.544). Furthermore, all patients showed a high quality of visualization of the glottis (Cormack and Lehane Grade I). For safety outcomes, the incidence and severity of epistaxis during intubation was comparable between the two groups. There were no significant differences between the selection of nostrils and intubation-related adverse events up to 24 h after surgery. Conclusions: When considering which nostril to use for intubation with video rigid stylet, either nostril can be used similarly.