“J”状塑型双腔气管导管插管操作对其成功率及术后声音嘶哑咽喉痛的影响

“J”状塑型双腔气管导管插管操作对其成功率及术后声音嘶哑、咽喉痛的影响TheeffectofJshapeofdouble-lumenendotrachealtubeonthesuccessrateofintubationandpostoperativehoarsenessandsorethroat作者姓名：吕晓红领域（方向）：麻醉学指导教师：王虎山副教授类别：临床医学硕士答辩日期：2015年5月26日I中文摘要“J”状塑型双腔气管导管插管操作对其成功率及术后声音嘶哑、咽喉痛的影响目的：观察双腔气管导管（double-lumenendotrachealtube,DLT）塑型对插管成功率及术后声音嘶哑（声嘶）、咽喉痛的影响，从而为寻求更好的DLT塑型插管提供依据。方法：择期全麻下行胸科手术患者160例，美国麻醉医师协会（ASA）分级Ⅰ~Ⅲ级，参照随机数字表法分成DLT插管塑型组和非塑型组（每组80例），两组根据左右DLT插管各分为两组（A、B、C、D组，每组40例），又根据性别再各分为两个亚组（A1、A2、B1、B2、C1、C2、D1、D2组，每组20例）。两组均采用经口明视气管插管，塑型组采用塑成“J”状的DLT进行插管，非塑型组采用未经塑型保留原有弯度的DLT进行插管。观察DLT插管时间、插管尝试次数及插反情况，患者术后声嘶、咽喉痛发生率及严重程度。结果：塑型组插管时间（154±6）s，非塑型组插管时间（185±13）s，塑型组明显短于非塑型组（P＜0.05）；塑型组插管尝试次数（1.4±0.4）次，非塑型组插管尝试次数（1.7±0.8）次，塑型组明显少于非塑型组（P＜0.05）；塑型组插反情况3次，非塑型组插反情况11次，塑型组明显比非塑型组少（P＜0.05），且与性别无关，但左DLT比右DLT易于插反（P＜0.05）。患者术后声嘶发生率塑型组15/80，非塑型组33/80，塑型组明显低于非塑型组（P＜0.05）；患者术后咽喉痛发生率塑型组15/80，非塑型组31/80，塑型组明显低于非塑型组（P＜0.05），II且与性别有关，女性较男性术后易发生声嘶、咽喉痛。结论：“J”状DLT塑型插管成功率高，刺激小，可减少患者术后声嘶、咽喉痛发生率，具有一定的临床推广意义。关键词：“J”状塑型双腔气管导管，插管成功率，声音嘶哑，咽喉痛IIIAbstractTheeffectofJshapeofdoublelumenendotrachealtubeonthesuccessrateofintubationandpostoperativehoarsenessandsorethroatObjective:Toobservethesuccessrateofintubationofshapingdouble-lumenendotrachealtube（DLT）andpostoperativehoarseness,sorethroat,andtoseekbetterDLTshapingprovidesthebasisforintubation.Methods:OnehundredandsixtypatientsofASAⅠ~Ⅲwithelectivethoracicsurgeryundergeneralanesthesia,randomlydividedintotheshapegroupandthenoshapegrouptointubateDLT（n=80）.EachgroupaccordingtoeachDLTisdividedintotwogroups（groupA,B,C,D,n=40）,andaccordingtogenderandeachisdividedintotwosubgroups（groupA1,A2,B1,B2,C1,C2,D1,D2,n=20）.Twogroupsallusebrighttracheaintubationthroughthemouth,shapegroupadoptstheJshapeofDLT.Thedatarelatedtointubationandpositioningisrecorded:intubationtime,intubationattemptsandthesituationofreversing,theincidenceandseverityofpostoperativehoarsenessandsorethroatisassessed.Results:Theintubationtimeofpatientsintwogroupsis（154±6）sand（185±13）srespectively,intubationattemptsofpatientsintwogroupsare（1.4±0.4）timesand（1.7±0.8）timesrespectively,andtimesofreversingofpatientsintwogroupsare3timesand11timesrespectively.Comparingbetweenthetwogroupsforintubationtime,intubationattemptsandthesituationofreversing,shapegrouparelessthanthenoshapegroup（P＜0.05）,andthathasnothingtodowithgender,buttheIVleftDLTthantherightiseasytoreverse（P＜0.05）.Theincidenceofpostoperativehoarsenessintwogroupsis15/80and33/80respectively,theincidenceofpostoperativesorethroatintwogroupsis15/80and31/80respectively.Theincidenceofpostoperativehoarsenessandsorethroat,theshapegroupsetslowerthanthenoshapegroupoverall（P＜0.05）,andisassociatedwithgender.Conclusions:JshapeDLTintubationhasthehighersuccessrateandthesmallerstimulation,canreducetheincidenceofpatientswithpostoperativehoarseness,sorethroat,andhasacertainclinicalsignificance.Keywords:Jtypeshapingdouble-lumenendotrachealtube,Successrateofintubation,Hoarseness,SorethroatV目录第1章引言..........................................................................................1第2章综述..........................................................................................22.1PH的相关研究及进展...............................................................22.1.1声音嘶哑的定义及发音机制..............................................22.1.2声音嘶哑的诊断..................................................................32.1.3PH的相关危险因素............................................................42.1.4PH严重程度的评估............................................................42.1.5PH的原因、预防及治疗....................................................52.2胸外科手术的特殊性.................................................................92.3双腔支气管导管插管的特殊性...............................................102.4总结............................................................................................10第3章资料与方法................................................................................113.1病例选择标准...........................................................................113.2病例排除标准...........................................................................113.3材料............................................................................................113.4实验方法...................................................................................113.4.1实验分组..............................................................................123.4.2麻醉方法..............................................................................133.4.3观察指标...............................................................................143.5统计学处理...............................................................................14第4章结果......................................................................................154.1一般资料...................................................................................15VI4.2各组插管时间，插管尝试次数及插反情况比较...................154.3患者术后声嘶、咽喉痛发生率比较.......................................17第5章讨论........................................................................................20第6章结论..............................