【罂粟摘要】经环甲膜的红外闪光引导柔性支气管镜清醒插管：一项随机交叉研究

经环甲膜的红外闪光引导柔性支气管镜清醒插管：一项随机交叉研究

贵州医科大学    麻醉与心脏电生理课题组

翻译：马艳燕  编辑：潘志军  审校：曹莹

背景：在气道解剖扭曲的情况下，使用柔性支气管镜进行清醒插管可能非常困难，甚至不可能。为了解决这种困难的操作，可以将红外闪光光源放置在患者环甲膜表面。光穿过皮肤和组织到达气管，在那里它可以被咽部前进的支气管镜记录下来，并在监视器上看到闪烁的白光。我们假设，这项技术的应用将使患有严重呼吸道病变的患者能够更近距离和更容易地识别到气管的正确路径。

方法：作为清醒插管的一部分，我们将柔性可视支气管镜通过患者口腔插入气管。每个患者在使用和不使用经皮闪光红外光的情况下，按随机顺序进行了两次操作。所有插入都进行了视频记录，以确定在气道内的哪个解剖标志处识别出正确的通路。预定义的标志点依次为：口腔、口咽、会厌尖端、杓状软骨、假索、声带和气管，以及它们之间的间隙。

结果：22例患者使用柔性支气管镜共进行了44次清醒插管。在监视器上正确识别气管的中位解剖水平，使用常规技术时通过会厌，并且在使用红外闪光时在口咽水平（p =0.005）。在激活和未激活红外闪光灯的插入过程中，看到闪光灯或声带的时间分别为21（22）S和48（62）S（平均值，SD）（p = 0.005）。内镜医生认为（p = 0.001）红外组更容易识别气管入口。

结论：在气道病变患者清醒插管期间，应用经环甲膜红外闪光灯引导柔性支气管镜的插入显著地促进了气管通路的识别和柔性内窥镜的正确推进。

原始文献来源：

Kristensen MS, Hesselfeldt R, Brinkenfeldt HK, Biro P. Infrared flashing light through the cricothyroid membrane as guidance to awake intubation with a flexible bronchoscope: A randomised cross-over study. Acta Anaesthesiol Scand. 2023 Jan 23.

英文原文     

Infrared flashing light through the cricothyroid membrane as guidance to awake intubation with a flexible bronchoscope: A randomised cross-over study

Background: In case of distorted airway anatomy, awake intubation with a flexible bronchoscope can be extremely difficult or even impossible. To facilitate this demanding procedure, an infrared flashing light source can be placed on the patient's neck superficial to the cricothyroid membrane. The light travels through the skin and tissue to the trachea, from where it can be registered by the advancing bronchoscope in the pharynx and seen as flashing white light on the monitor. We hypothesised that the application of this technique would allow more proximal and easier identification of the correct pathway to the trachea in patients with severe airway pathology.

Methods：As part of awake intubation, patients underwent insertion of a flexible video bronchoscope via the mouth into the trachea. The procedure was performed twice, in random order in each patient, with and without the aid of the transcutaneous flashing infrared light. All insertions were video recorded to determine at which anatomical landmark within the airway the correct pathway was identified. The videos are accessible via this link: https://airwaymanagement.dk/infrared_comparative. The predefined landmarks were in successive order: oral cavity, oro-pharynx, tip of epiglottis, arytenoid cartilages, false cords, vocal cords and trachea, as well as the spaces between them.

Results：Twenty-two patients had a total of 44 awake insertions with the flexible bronchoscope. The median anatomical level, at which correct identification of the trachea was obtained on the monitor, was, past the epiglottis, with the conventional technique, and at the level of the oropharynx, when using the infrared flashing light (p = .005). The time until the flashing light or the vocal cords were seen was 21 (22) S, mean (SD), and 48 (62) S, during the insertion with and without infrared flashing light activated, respectively (p = .005). Endoscopists rated it easier (p = .001) to recognise the entrance to the trachea in the infrared-group.

Conclusion：During awake intubation of patients with airway pathology, the application of trans-cricothyroid infrared flashing light to guide the insertion of a flexible bronchoscope significantly facilitated the recognition of the pathway into the trachea and the correct advancement of the flexible endoscope.

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