目的 探讨在预期困难气道患者中采用喉罩辅助纤维支气管镜（fiberoptic bronchoscope， FOB）引导气管插管的应用价值。 方法 择期经口气管插管全身麻醉手术预测困难气道患者24例，ASAⅠ或Ⅱ级，入选患者达到以下1种或几种条件为预期困难气道：1.5 cm<张口度<3 cm，甲颏间距<6 cm，头颈活动度<80°，Mallampati分级Ⅲ、Ⅳ级。采用随机数字表法分为喉罩辅助FOB组（F组）和直接喉镜组（L组），每组12例。F组采用喉罩辅助FOB引导下气管插管；L组在直接喉镜暴露下经口气管插管，3次试插未成功者改行F组方法试插。记录两组患者的气道评估情况、气管插管前（基础值）和插管后3 min的MAP和HR、成功插管的次数及术后的并发症的发生情况。 结果 插管前两组气道评估差异无统计学意义（P>0.05）。与插管前相比，L组患者插管后MAP和HR显著增加，差异有统计学意义（P<0.05）。两组插管后的MAP和HR比较，差异有统计学意义（P<0.05）。F组气管插管一次成功率为75%，3次以内插管合计总成功率为100%；L组气管插管一次成功率为25%，3次以内插管合计总成功率为50%；6例L组患者直接喉镜3次插管不成功后改为喉罩辅助FOB插管，2例1次成功，4例2次成功；F组一次插管成功率和3次插管总成功率均显著高于L组，两组比较差异有统计学意义（P<0.05）。与L组插管时间（161±26） s比较，F组插管时间（81±9） s明显缩短，差异有统计学意义（P<0.05）。F组有2例术后轻度咽喉疼痛，L组有6例术后咽喉疼痛明显和轻度声嘶、2例轻度咽痛。 结论 对术前预期为困难气道的患者采用喉罩辅助FOB引导气管插管可显著提高插管的成功率，降低直接喉镜反复试插引起的术后并发症，具有一定的临床应用价值。
Ｏｂｊｅｃｔｉｖｅ To estimate the clinical value of fiberoptic bronchoscopy(FOB)-guided tracheal intubation with laryngeal mask airway in anticipated difficult airways patients. Methods Twenty four ASA ⅠorⅡpatients scheduled for elective general anesthesia surgery with one or several difficult intubation criterion (thyromental distance<6 cm, 1.5 cm0.05). Compared with the value of basement, the MAP and HR increased significantly in the patients of the L group(P<0.05), but not in the F group(P>0.05). There is significant difference between L group and F group(P<0.05). The first intubation attempt succeeded in 75% of the patients in the F group and the total success rate was 100%, though the success rate was only 25% at the first attempt in the L group and the total rate of success was 50% after three attempts. Six cases failed with direct laryngeal scope after three attempts, then two of them intubated successfully with FOB aided by LMA at the first attempt and four of them succeeded at the second time. The rate of success of first attempt and the total rate of three attempts in the F group were higher than the L group. There was significant difference between the two groups (P<0.05). The duration of intubation in the F group was shorter significantly than that in the L group [(81±9) s vs (161±26) s ](P<0.05). There were two cases in the F group who had mild sore throat. Six cases had moderate to severe sore throat and mild hoarseness and two cases had mild sore throat in the L group. Conclusions Laryngeal mask airway combining with fiberoptic bronchoscope intubation in anticipated difficult airways was effective to improve the success rate of intubation and reduce adverse effects of direct laryngoscope intubation postoperatively. It is worthy of clinical application.
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