Truview^(TM)EVO_2光学喉镜与Macintosh直接喉镜用于颈椎手术患者气管插管的比较  

Comparison between Truview^(TM)EVO_2 optic laryngoscope and Macintosh laryngoscope in patients receiving cervical vertebral surgery

作　　者：杜健儿[1] 王天舒[1] 范晓华[1] 李金宝[1] 邓小明[1] 

机构地区：[1]第二军医大学长海医院麻醉科,上海200433

出　　处：《第二军医大学学报》2008年第5期525-530,共6页Academic Journal of Second Military Medical University

摘　　要：目的:在颈椎手术患者中比较Truview^(TM)EVO_2光学喉镜与Macintosh直接喉镜在经口气管插管时对喉部结构的显露效果。探讨该光学喉镜在此类患者中的应用价值。方法:100例颈椎手术患者,随机分为A、B两组.每组50例.麻醉诱导后A组先用Macintosh直接喉镜显露喉部结构并记录Cormack—Lehane分级(C/L分级),不插管。再改用Truview^(TM)EVO_2光学喉镜显露喉部结构并插入气管导管。B组先用光学喉镜显露声门,再使用直接喉镜显露喉部结构并插管。观察指标包括患者术前一般情况及气道评估指标(体质指数、甲颏间距、下颌支长度、张口度、颈部活动度,Mallampati分级).喉镜显露的C/L分级.插管时间.喉镜力量,显露难度和插管并发症。结果:A、B两组间比较,一般情况、术前气道评估指标、C/L分级和插管时间均无显著性差异,而喉镜力量A组显著低于B组(P<0.05),即Truview^(TM)EVO_2光学喉镜插管时力量小于直接喉镜;光学喉镜的C/L分级(Ⅰ级:Ⅱ级;Ⅲ级为69:26:5)显著优于直接喉镜(Ⅰ级:Ⅱ级:Ⅲ级为26:46:28,P<0.001);光学喉镜显露困难有5%,显著优于直接喉镜的28%(P<0.001);C/L分级、喉镜力量与术前气道评估指标的分级相关(P均<0.05)。结论:Truview^(TM)EVO_2光学喉镜对喉部结构的显露和插管力量均优于Macintosh直接喉镜,提示应用光学喉镜有助于颈椎手术患者的气管插管处理。Objective： To evaluate the clinical value of Truview^TM EVO2 optic laryngoscope by comparing it with the Macintosh laryngoscope in patients receiving cervical vertebral surgery. Methods： One hundred patients scheduled for elective cervical vertebral surgery were enrolled in this randomized crossover study. After induction, the patients＇ glottis in group A （n=50） was displayed by Macintosh laryngoscope and the Cormack Lehane （C/L） grade was recorded, and then optic laryngoscope was employed to display the laryngeal structure. The order of laryngoscopy attempts was reversed in group B （ n： 50）. Parameters recorded included demographics, airway assessment features （BMI, thyromental distance, mandibular size, mouth opening,mallampati oropharyngeal scale, and neck movement）, C/L grade, laryngoscopic force applied, duration of intubation, difficulties of laryngeal view and injury of upper airway. Results： There were no significant difference in demographics, airway assessment features,C/L grade and duration of intubation between the 2 groups,whereas the laryngoscopic force in group A was significantly lower than that in group B （P 〈 0. 05）. The C/L grade obtained with optic laryngoscope was 69 ： 26 ： 5 （ Ⅰ ： Ⅱ ： Ⅲ ） ,which was significantly better than that with Macintosh laryngoscope （26 ： 46 ： 28,P〈0. 001）. A poor laryngeal view of 5% was obtained with optic laryngoscope,which was significantly better than that with Macintosh laryngoscope （28%, P〈0. 001）. There was significant association between airway assessment features and C/L grade or laryngoscopic force （P〈 0.05）. Conclusion： The TruviewTM EVO2 optic laryngoscope has better glottic view and lighter laryngoscopic force than those of Macintosh laryngoscope,and may have potential advantages for managing the difficult airways for cervical vertebral surgery.

关 键 词：TRUVIEW^TM EVO2光学喉镜 MACINTOSH直接喉镜 气管插管 颈椎 

分 类 号：R608[医药卫生—外科学]