困难气道中运用CT 三维重建技术指导硬质纤维气管镜行气管插管

doi:10.19723/j.issn.1671-167X.2019.05.013

摘要/Abstract

摘要：

目的:研究困难气道中运用CT 三维重建技术指导硬质纤维气管镜行气管插管的效果。方法: 选择美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级、颈项强直、颈部外伤需制动或严重颈椎病颈椎固定的择期手术患者44例,随机分为两组,试验组(E组)24例和对照组(C组)20例。术前采集入组患者上气道CT 数据,依据患者的CT三维重建图像及由此获得的参数计算完成对Shikani硬质纤维气管镜(后简称硬质镜)管芯塑型,随机分组后,根据患者所在组别分别选用相应的硬质镜插管,E组采用根据患者CT三维重建图像计算的角度塑型后的硬质镜,C组采用原始角度硬质镜,并记录首次插管成功率及气管插管成功率,气管插管时间,入室(Tb)、插管后即刻(T0)、插管后5 min内(T1~T5)7个时间点血压、心率和脉搏氧饱和度,以及24 h内气管插管相关并发症。结果: 两组插管成功率均为100%,E组首次插管成功率为96%,C组首次插管成功率为70%,E组首次插管成功率高于C组。E组插管时间为(20.7±10.6) s,C组插管时间为(21.5±17.6) s,E组优于C组,但差异无统计学意义(P>0.05)。插管操作对血流动力学影响方面,E组心率血压乘积(rate-pressure product,RPP)在T0、T1、T2、T4、T5小于C组,但差异无统计学意义(P>0.05),两组气管插管相关并发症差异无统计学意义(P>0.05)。结论: 依据CT三维重建技术图像计算的角度对硬质镜管芯塑型,对提高颈椎固定困难气道患者的首次气管插管成功率具有一定指导意义。

关键词: CT三维重建技术, 硬质纤维气管镜, 颈椎固定, 困难气管插管

Abstract:

Objective: To evaluate the significance of CT three-dimensional reconstruction technique for guiding tracheal intubation with rigid fiber bronchoscope in difficult airway. Methods: In this study, 44 patients undergoing selective operation of ASA (American Society of Anesthesiologists physical status) Ⅰ to Ⅱ, neck stiffness, neck trauma needed braked, or severe cervical spondylosis were selected. The patients were randomly divided into two groups: 24 cases in the experimental group (group E) and 20 cases in the control group (group C). The stylets of the rigid fiber bronchoscopes were shaped according to the CT three-dimensional reconstruction images and parameters obtained before surgery. The rigid fiber bronchoscopes shaped according to the CT three-dimensional reconstruction images were used in group E, while the rigid fiber bronchoscopes with the original angles were used in group C. Tracheal intubation operations were all performed by an anesthesiologist who had more than 10 years’ clinical experience and mastered in rigid endoscopic intubation techniques. The first attempt success rate and the total success rate of tracheal intubation, intubation time, blood pressure, heart rate and pulse oxygen saturation at different time points including pre-induction, immediately after intubation, 1-5 minutes after intubation, and intubation related complications within 24 hours were recorded. Results: The total success rate of intubation in the two groups were both 100%. The first attempt success rate of intubation was 96% in group E, and 70% in group C. The first attempt success rate of group E was higher than that of group C. The intubation time of group E was (20.7± 10.6) s, and (21.5 ± 17.6) s of group C. Group E was shorter than that of group C, but there was no significant difference (P > 0.05). RPP equaled the product of heart rate and systolic pressure, which represented the stress reaction of intubation on hemodynamics, was lower in group C at T0, T1, T2, T4 and T5 separately than that in group E, but there was no significant difference (P>0.05). There was no significant difference in tracheal intubation related complications between the two groups (P>0.05). Conclusion: CT three-dimensional reconstruction technique has certain guiding significance in difficult tracheal intubation with rigid fiber bronchoscope in patients with fixed cervical spine.

Key words: CT three-dimensional reconstruction technique, Rigid fiber bronchoscope, Fixed cervical spine, Difficult tracheal intubation

中图分类号:

R614

洪洪,钱宇婷,付磊,王武,李成辉,尹毅青. 困难气道中运用CT 三维重建技术指导硬质纤维气管镜行气管插管[J]. 北京大学学报（医学版）, 2019, 51(5): 870-874.

Hong HONG,Yu-ting QIAN,Lei FU,Wu WANG,Cheng-hui LI,Yi-qing YIN. Study on the use of CT three-dimensional reconstruction technique for guiding tracheal intubation with rigid fiber bronchoscope in difficult airway[J]. Journal of Peking University(Health Sciences), 2019, 51(5): 870-874.

图/表 6

图1

图2

表1

两组患者一般情况各指标的比较"

Group	Gender, male/female	Age/years, $x ?$ ±s	Height/cm, $x ?$ ±s	Weight/kg, $x ?$ ±s	BMI/(kg/m²), $x ?$ ±s
E	15/9	55.6±8.6	165.8±8.2	71.1±19.2	25.9±7.2
C	10/10	57.4±14.0	164.2±7.0	64.6±12.2	23.8±3.1
P	0.405	0.625	0.483	0.200	0.245

表1

表2

气道相关评估指标的比较"

Group	Angle of upper airway measurement on CT imaging/(°), $x ?$ ±s	OSAS, yes/no	Mouth opening/cm, $x ?$ ±s^*	Thyromental distance/cm, $x ?$ ±s
E	89.63±10.35	16/8	4.60±0.59	4.42±0.87
C	85.65±7.85	9/11	4.65±0.49	4.90±0.94
P	0.165	0.149	0.783	0.510
Group	Front teeth missing, yes/no	Upper lip bite test, Ⅰ/Ⅱ/Ⅲ	Length of mandibular ramus/cm, $x ?$ ±s	Cormack-lehaneclassifcation, Ⅰ/Ⅱ/Ⅲ/Ⅳ
E	22/2	8/12/4	8.44±1.45	1/5/13/5
C	19/1	12/5/3	8.68±1.35	1/1/15/3
P	0.662	0.175	0.580	0.396

表2

图3

表3

插管及并发症相关数据"

Group	First attempt success rate of intubation/%	Intubation time/s, $x ?$ ±s	TbRPP/[×10³ beat/ (min·mmHg)], $x ?$ ±s	T0RPP/[×10³ beat/ (min·mmHg)], $x ?$ ±s	T1RPP/[×10³ beat/ (min·mmHg)], $x ?$ ±s
E	96(23/24)	20.7±10.6	7.9±2.1	9.2±2.4	9.7±2.2
C	70(14/20)	21.5±17.6	7.0 ±1.9	9.4±3.1	9.9±2.9
P	0.035	0.880	0.149	0.846	0.810
Group	T2RPP/[×10³ beat/ (min·mmHg)], $x ?$ ±s	T3RPP/[×10³ beat/ (min·mmHg)], $x ?$ ±s	T4RPP/[×10³ beat/ (min·mmHg)], $x ?$ ±s	T5RPP/[×10³ beat/ (min·mmHg)], $x ?$ ±s	Post-operative complication rate/%
E	8.5±2.0	8.1±1.8	7.5±1.5	7.1±2.0	37.5 (9/24)
C	8.8±2.5	8.1±2.1	7.7±1.8	7.5±1.8	15 (3/20)
P	0.655	0.982	0.780	0.504	0.201

表3

参考文献 13

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