摘要
[目的]探讨超声引导下的环甲膜穿刺术在疑难型气管插管中的应用效果.[方法]选取 2018 年 1月至 2020 年 1 月在镇巴县中医院及镇巴县人民医院行超声引导下的环甲膜穿刺术的 76 例疑难型气管插管患者,按照随机数字表法分为对照组和观察组,每组 38 例.对照组采用体表定位法的环甲膜穿刺术,观察组采用超声引导下的环甲膜穿刺术.比较两组患者环甲膜一次穿刺成功率、插管舒适度、气管导管耐受性评分以及术后并发症情况;并记录麻醉前(T0)、麻醉时(T1)、气管插管时(T2)及插管后 5 min(T3)的血氧饱和度(SpO2)、心率(HR)、平均动脉压(MAP).[结果]观察组患者环甲膜一次穿刺成功率为 100%,显著高于对照组的 84.21%,差异有统计学意义(χ2 =6.514,P =0.011).两组患者T1、T2、T3 时的 SpO2、HR、MAP较 T0均升高,但观察组低于对照组(P<0.05);两组患者 T3 时 SpO2、HR、MAP 指标较 T1、T2 时均降低(P<0.05).观察组患者插管舒适度评分和气管导管耐受性评分均低于对照组(P<0.05).观察组患者术后并发症发生率为 18.42%,显著低于对照组的 47.37%,差异有统计学意义(χ2=7.213,P =0.007).[结论]超声引导下的环甲膜穿刺术在疑难型气管插管患者中的应用效果较好,可提高环甲膜穿刺成功率和患者插管舒适度及气管导管耐受性,且可降低并发症的发生率.
Abstract
[Objective]To explore the effect of cricothyroid membrane puncture(cricothyroidotomy)in difficult tracheal intubation guided by ultrasound.[Methods]A total of 76 patients with intractable tracheal intubation who were hospitalized in Zhenba County People's Hospital and Zhenba Hospital of Traditional Chinese Medicine from Janu-ary 2018 to January 2020 were selected in the study.According to the random number table method,patients were di-vided into the control group and the observation group(with 38 cases each).The control group was treated with cri-cothyroid membrane puncture by body surface positioning method,while the observation group was applied with ul-trasound-guided cricothyroidotomy.The success rate of one-time puncture of cricothyroid membrane,intubation com-fort and tracheal tube tolerance scores in the two groups of patients were compared.The blood oxygen saturation(SpO2),heart rate(HR),mean arterial pressure(MAP)in both groups,at pre-anesthesia(T0),anesthesia(T1),tracheal intubation(T2)and 5 minutes after intubation(T3)were recorded and postoperative complications was ana-lyzed.[Results]The success rate of cricothyroid membrane puncture in the observation group was 100%.The obser-vation group had a higher success rate of puncture of the cricothyroid membrane than the control group(100%vs 84.21%)(χ2=6.514,P =0.011).The SpO2,HR,and MAP indexes of T1,T2,and T3 in both groups were higher than those of T0,and those parameters of the observation group were lower than those of the control group(P<0.05).The SpO2,HR,and MAP indexes at T3 were lower than those at T1 and T2(P<0.05).The observation group's intubation comfort score and tracheal tube tolerance score were lower than the control group(P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group(18.42%vs 47.37%)(χ2=7.213,P =0.007).[Conclusion]Ultrasound-guided cricothyroid membrane puncture can better meet the needs of difficult tracheal intubation patients,improve the success rate of cricothyroid membrane puncture,intubation comfort and tolerance,and reduce the occurrence of complications.
维普
万方数据