Softened Endotracheal Tube Reduces the Incidence and Severity of Epistaxis Following Nasotracheal Intubation

軟化的氣管內管可以減少經鼻插管後的鼻出血

呂保平(Pao-Ping Lu) ； 劉宏濱(Hung-Pin Lin) ； 石明煌(Ming-Hwang Shyr) ； 何綺月(Angie C. Y. Ho) ； 王永良(Yung-Liang Wang) ； 譚培炯(Peter P. C. Tan) ； 楊承憲(Chen-Hsien Yang)

《Acta Anaesthesiologica Sinica》 36卷4期 (1998/12) Pp. 193-197

https://doi.org/10.6955/AAS.199812.0193

摘要

背景：經鼻插管時常會伴隨許多併發症，最主要的是鼻道傷害及鼻腔出血；有各種不同的方法會被使用來減少此類併發症，包括利用化學藥物或是改良插管技術，但其效果仍有爭論。在本實驗中我們進行一項前瞻性、隨機的單盲研究，探討使用溫水軟化後的氣管內管進行經鼻插管時，是否可以降低鼻出血的發生率及嚴重度。
方法：我們選擇六十二位接受常規手術的健康病人，屬於ASA體位分類Ⅰ或Ⅱ，隨機分成兩組：加溫組的病人是使用事先加熱軟化的氣管內管進行經鼻插管；控制組的病人則使用正常的氣管內管進行插管。在完成經鼻插管後立刻評估鼻出血的情況並依程度分成無、輕微、中度及嚴重。同時紀錄插管時是否使用Magill鉗輔助插和及手術後是否有鼻腔的併發症。
結果：控制組的病人鼻出血的發生率顯著高於加溫組(76.7%vs. 43.8%, P=0.0002)。至於鼻腔出血的嚴重程度則是加溫組的病人明顯不如控制組來得嚴重。當使用加熱軟化的氣管內管時並不會增加插管時的技術困難度。手術後的鼻腔併發症在兩組間並沒有顯著差異。
結論：我們的研究顯示利用溫水加熱的方法，是一種簡單方便、可有效軟化氣管內管的方法；而使用軟化的氣管內管進行經鼻插管時，可以顯著降低經鼻插管時鼻出血的發生率及嚴重度。

關鍵字

氣管內置管 ； 鼻出血

並列摘要

Background: Many complications were reported to be related with nasotracheal intubation. Various chemical or mechanical techniques have been proposed to decrease hemorrhage and trauma associated with nasotracheal intubation but the results remain controversial We conducted a prospective, randomized, single-blind study to elucidate the effect of an endotracheal tube softened with warm water before use on the incidence and severity of epistaxis following nasotracheal intubation.
Methods: Sixty-two healthy, (ASA class Ⅰor Ⅱ) patients scheduled for elective surgery were randomly assigned into two groups. Patients in the treatment group were intubated with a softened endotracheal tube made possible by heating it in warm water while those in the control group were intubated with unsoftened (intact) tube. Epistaxis was evaluated immediately after intubation and its severity was graded as none, mild, moderate and severe. The use of Magill forceps and postoperative nasal morbidity were also recorded.
Results: The total incidence of epistaxis in the “unsoftened” group was significantly higher than that of “softened” group (76.7% vs. 43.8%, P=0.0002). The severity of nasal hemorrhage was also significantly lightened in the “softened” group. No technical difficulty was encountered in intubation with a softened endotracheal tube by prewarming. The morbidity referable to nasal intubation, however; did not differ in both groups.
Conclusions: In conclusion, our study shows that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during the act of nasotracheal intubation. It is an effective way and worth a try.

並列關鍵字

Intubation, intratracheal.Epistaxis