声门显露困难者使用GlideScope可视喉镜行双腔支气管插管的可行性研究  

Comparison between GlideScope and Macintosh laryngoscope for double-lumen endobronchial tube intubation in patients with difficult glottis exposure

作　　者：承耀中[1] 孙莉[1] 武小勇[1] 丁超[1] 郑春京[1] 赵桂军[1] 

机构地区：[1]中国医学科学院肿瘤医院麻醉科,北京100021

出　　处：《中国肿瘤临床与康复》2011年第3期274-277,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的观察与普通喉镜相比,GlideScope可视喉镜用于Mallampati评分Ⅲ~Ⅳ级的胸部肿瘤患者行双腔支气管插管时的可行性和临床应用价值。方法选择40例术前评估Mallampati评分Ⅲ~Ⅳ级的食管癌或者肺癌患者,随机分为G组和M组,每组20例,分别采用GlideScope视频喉镜和普通直接喉镜进行双腔支气管插管,记录插管一次成功的人数、需要环状软骨压迫的人数以及声门暴露程度,并记录气管插管时间。结果声门显露情况：Cormack＆Lehanef分级：M组Ⅰ级2例,Ⅱ级1例,Ⅲ级12例,Ⅳ级5例,G组声门显露明显改善,其中Ⅰ级16例,Ⅱ级4例,Ⅲ级0例,Ⅳ级0例。两组患者的一次插管成功率分别为：G组90.0%,M组50.0%,G组显著高于M组（P〈0.05）;需要喉部按压的例数：G组2例次,M组18例次。两组患者气管插管时间：G组（51.3±23.4）s,M组（66.2±26.6）s,G组插管时间显著短于M组（P〈0.05）。结论 GlideScope可视喉镜用于声门显露困难的双腔支气管插管时比使用普通直接喉镜安全、有效,插管成功率高,为解决临床问题提供了一条行之有效的途径。Objective To compare the use of GlideScope and conventional Macintosh laryngoscope in difficult glottis exposure during surgery on malignant chest tumors.Methods Forty Mallampati Ⅲ and Ⅳ patients during surgery on malignant chest tumors were recruited to our randomized controlled trial.Group G（n=20）had endobronchial intubation performed using GlideScope and Group M（n=20） underwent endobronchial intubation using a Macintosh laryngoscope.The best laryngeal view,difficulty of the tracheal intubation,time taken for successful endobronchial intubation,manoeuvre needed to aid tracheal intubation were recorded.Results The median Cormack and Lehane grade was significantly better in Group G than in Group M.Group G had a significantly shorter endobronchial intubation time than Group M[（mean 51.3±SD 23.4）s vs（mean 66.2±SD 26.6）s,P0.05）].Conclusion The GlideScope improved the laryngeal view and decreased time for endobronchial intubation as compared with the Macintosh laryngoscope in patients with difficult glottis exposure.The GlideScope may be a good alternative for managing the difficult airway.

关 键 词：胸部肿瘤 双腔支气管插管 Mallampati评分 GlideScope可视喉镜 

分 类 号：R614[医药卫生—麻醉学]