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

Abstract

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

CLC Number:

R614

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.

Figures/Tables 6

Figure 1

Figure 2

Table 1

Demographic data of two groups"

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

Table 1

Table 2

Patient airway assessment"

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

Table 2

Figure 3

Table 3

Intubation data and complications"

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

Table 3

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Study on the use of CT three-dimensional reconstruction technique for guiding tracheal intubation with rigid fiber bronchoscope in difficult airway

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