本文選題：Clarus可視管芯 + 氣管插管��； 參考：《廣州中醫(yī)藥大學》2017年碩士論文

【摘要】：第一部分:Clarus可視管芯視頻法和頸前光斑法引導氣管插管的臨床觀察目的:觀察Clarus可視管芯引導氣管插管的臨床效果,比較視頻法和頸前光斑法兩種操作技術對Clarus可視管芯引導氣管插管的影響。方法:110例ASA 1～11級,擬全麻下行經(jīng)口氣管插管的成年患者,隨機分為視頻組和頸前光斑組。在常規(guī)麻醉誘導后,由同一位熟練運用Clarus可視管芯的麻醉醫(yī)師運用此工具采用視頻法或頸前光斑法行氣管插管操作。記錄各組氣管插管操作總時間、確定聲門或氣管環(huán)的時間、插管次數(shù)、插管成功率、血流動力學改變、插管相關并發(fā)癥情況。結果:頸前光斑組和視頻組插管操作中位時間為28.67s和29.72s,其中頸前光斑組確認聲門或氣管環(huán)的時間較視頻組縮短,兩組差異具有統(tǒng)計學意義(P0.05)。頸前光斑組插管總成功率高于視頻組(100%VS 96.15%)。其中視頻組有2例插管失敗,改用頸前光斑法操作后順利插管成功。兩組插管操作引起的血流動力學變化相近。結論:Clarus可視管芯引導氣管插管,具有方便快捷、可操性強、對血流動力學影響小等優(yōu)點。對比視頻法,頸前光斑法通過對體表甲狀軟骨處頸前光點的判斷,能直接將Clarus可視管芯的前端移動到聲門附近,縮短確認聲門及氣管環(huán)結構的時間并提高插管成功率。但頸前光斑法為半盲探操作技術,在臨床中仍應根據(jù)病人具體情況選擇合適的操作方法以減少不必要的盲探損傷。第二部分:視頻法和頸前光斑法對Clarus可視管芯氣管插管學習曲線的影響目的:比較視頻法和頸前光斑法兩種操作技術對Clarus可視系統(tǒng)管芯引導氣管插管的學習曲線的影響。方法:選取能熟悉運用直接喉鏡但無Clarus可視管芯及其類似工具運用經(jīng)驗的第一二年的麻醉科住院醫(yī)師共10名為操作者,使用隨機數(shù)字表法將其分配為頸前光斑操作組和視頻法操作組,經(jīng)過正式培訓后,學員使用Clarus可視管芯采用相應的操作技術對擇期全麻手術患者進行插管。記錄每個學員完成25例患者氣管插管的操作時間,插管相關并發(fā)癥情況,統(tǒng)計插管成功率,用累積和(CUSUM)的方法建立學習曲線,最后各組累加每一位學員每一例操作時累積和的總和,作出兩組總體學習曲線圖。應用曲線多項式擬合程序得出插管例數(shù)與累積和值的曲線方程及曲線函數(shù)圖,算出掌握相應插管技術所需的最少例數(shù)。結果:兩組學員年齡、性別、受教育程度無統(tǒng)計學差異。視頻法操作組學員掌握插管技術最少需要17例,頸前光斑組為11例,頸前光斑組學習曲線優(yōu)于視頻法操作組(P0.05)。兩組學習曲線峰值前操作平均間隔時間及學習曲線峰值后插管退鏡操作時間無明顯統(tǒng)計學差異(P0.05)。結論:運用Clarus可視管芯行氣管插管是一項學習曲線短、操作上手快的實用性技能。對于正常氣道,采用頸前光斑技術時Clarus可視管芯的學習曲線優(yōu)于視頻法,該技術更適于初學者的學習訓練,值得在麻醉醫(yī)生及急救醫(yī)護人員學習和推廣。
[Abstract]:The first part: the clinical observation of Clarus visual tube core video method and anterior cervical spot method to guide tracheal intubation: observe the clinical effect of Clarus visual tube core guided tracheal intubation, compare the effect of two kinds of video and anterior cervical spot method on the Clarus visual tube core guided tracheal intubation. Methods: 110 cases of ASA 1~11, general anesthesia under general anesthesia The adult patients treated with oral tracheal intubation were randomly divided into video group and anterior cervical spot group. After routine anesthesia induction, the same anesthetized anesthettic with Clarus visual tube core used video or anterior cervical spot method to perform tracheal intubation. Record the total time of tracheal intubation and determine the time of glottis or tracheal ring. The number of intubation, the success rate of intubation, the change of hemodynamics, and the complications related to intubation. Results: the position time of the anterior cervical spot group and the video group was 28.67s and 29.72s, and the time of the anterior cervical spot group confirmed the glottis or the tracheal ring shorter than the video group, and the two groups were statistically significant (P0.05). The intubation assembly of the anterior cervical spot group was significant. The power of the video group was higher than that of the video group (100%VS 96.15%). In the video group, there were 2 cases of failure of intubation and successful intubation after the operation of the anterior cervical spot method. The hemodynamic changes caused by the two groups of intubation were similar. Conclusion: Clarus visual tube core guided tracheal intubation is convenient, fast, strong, and small influence on hemodynamics. Frequency method, the anterior cervical spot method can directly move the front of the Clarus visual tube to the glottis by judging the anterior cervical spot at the surface of the thyroid cartilage, which can shorten the time to confirm the structure of the glottis and the trachea and improve the success rate of intubation. But the anterior cervical spot method is a semi blind exploration technique, and should be selected according to the patient's specific condition in clinical. The second part: the effect of the video method and the anterior cervical spot method on the learning curve of the Clarus tube core tracheal intubation: comparison of the effect of two methods of video and anterior cervical spot on the learning curve of the tube guided tracheal intubation of the Clarus visual system. A total of 10 inpatients in the first two years of Anesthesiology with direct laryngoscope but without Clarus visual tube core and its similar tools were used as operators in the first two years of anesthesiology. They were assigned to the anterior cervical spot operation group and the video operation group by the random digital table method. After formal training, the students used the corresponding operation techniques of the Clarus visual tube for the selection. Patients undergoing general anesthesia were intubated. The operation time of 25 cases of tracheal intubation was recorded by each cadet, the complications of intubation, the success rate of intubation, and the cumulative and (CUSUM) methods were used to establish the learning curve. At last, the cumulative sum of each student was added to each case, and two groups of overall learning curves were made. The curve polynomial fitting program was used to obtain the curve equation and curve function diagram of the number of intubation and accumulation and value, and the minimum number of cases needed to master the corresponding intubation technology was calculated. Results: there was no statistical difference between the two groups of students' age, sex and education. The minimum requirement for intubation in the video operation group was 17 cases, and the anterior cervical spot group was 11 cases. The learning curve of the anterior cervical spot group was better than the video operation group (P0.05). There was no significant difference between the two groups of learning curves before peak time and the peak of learning curve. Conclusion: the use of Clarus visual tube core for tracheal intubation is a short learning curve and a practical skill to operate quickly. In the normal airway, the learning curve of the Clarus visual tube core is better than the video method when using the anterior cervical spot technique. This technique is more suitable for the learning and training of the beginners. It is worth learning and popularizing in the anesthesiologist and first aid medical staff.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

【參考文獻】

相關期刊論文 前6條

1 王劍;袁嵐;傅國強;于桂杰;唐煒;郭豐;;光斑法和直視法對Bonfils纖維光導硬鏡氣管插管學習曲線及并發(fā)癥的影響[J];中國內鏡雜志;2016年05期

2 陳朝輝;李軍祥;萬勇;劉洋;;視可尼喉鏡“光斑法”氣管插管的效果觀察[J];川北醫(yī)學院學報;2013年01期

3 薛富善;王強;程怡;;視頻喉鏡在氣道管理中應用的現(xiàn)況[J];國際麻醉學與復蘇雜志;2012年12期

4 黃海波;江志偉;鮑揚;黎介壽;;腹腔鏡胃癌D_2手術學習曲線的研究[J];醫(yī)學研究生學報;2011年09期

5 趙欣;田鳴;李樹人;;Levitan可視纖維氣管鏡4種氣管插管方法臨床比較[J];中國醫(yī)刊;2008年11期

6 隋靜湖;鄧曉明;魏靈欣;劉建華;楊冬;羅茂萍;胥琨琳;;頸前透光法用于Bonfils纖維光導硬鏡引導全麻患者氣管插管的可行性[J];中華麻醉學雜志;2007年09期

，

本文編號：1976716