旋转法经鼻气管插管的临床观察

目的 观察使用插管钳辅助（插管钳法）和旋转气管导管末端（旋转法）实施经鼻气管插管时临床效果.方法 选取2012年2～8月中国医学科学院北京协和医学院整形外科医院颅颌面手术中心ASA分级Ⅰ～Ⅱ级需经鼻气管插管患者100例,随机分为两组,每组各50例,插管钳组使用插管钳辅助插管,旋转组旋转气管导管插管.观察两组患者的喉镜暴露时间、气管置入时间、插管时间、插管成功率、术后并发症的发生情况以及插管期间的血流动力学变化.结果 两组插管成功率均为100％;插管钳组和旋转组的气管置入时间分别为（16.26±10.32）、（10.32±6.17）s,插管时间分别为（26.58±11.80）、（21.48±8.29）s,差异均有统计学意义（P＜0.05）;插管钳组术后咽喉部疼痛发生率显著高于旋转组,差异有统计学意义（P＜ 0.05）;两种插管方式插管对血流动力学影响较小.结论 直接喉镜下旋转法可以安全有效地应用于经鼻气管插管,与插管钳辅助法相比操作简单快捷、成功率高、并发症少.

Clinical observation of rotation tube in nasotracheal intubation

Objective To assess the clinical effects of the using of intubating forceps auxiliary （intubating forceps method） and rotating the terminal of the tube （rotation method） in nasotracheal intubation.Methods 100 patients of ASA Ⅰ or Ⅱ requiring nasotracheal intubation for elective surgery at the Facio-Maxillary Centre in Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from February to August 2012 were selected and divided into 2 groups with 50 cases in each group.Intubating forceps group was treated with intubating forceps auxiliary; rotation group were treated with rotation of the tube.The glottis exposure time,the trachea time,intubation time,success rate,postoperative complications and hemodynamics changes were recorded.Results The success rate of intubation were 100％ in the two groups; intubation time in intubating forceps group and rotation group were（16.26±10.32）,（10.32±6.17） s,the intubation time were （26.58± 11.80）,（21.48±8.29） s,the differences were statistically significant （P ＜ 0.05）.Incidence rate of throat pain in intubating forceps group was higher than that in rotation group,the difference was statistically significant （P ＜ 0.05）; the two groups had small haemodynamics effects.Conclusion The rotation method is a very safe and effective technique in nasotracheal intubation under direct laryngoscope.Compared with intubating forceps method,the rotation method is simple,quick,which has higher success rate and fewer complications.