McGrath-5型视频喉镜和直接喉镜在残齿老年患者气管插管中的比较  

Comparison of McGrath-5 video laryngoscopy and direct laryngoscopy applied in tracheal intubation for elderly patients with residual teeth

作　　者：严峰[1,2] 何伟[1] 杨建兵[3] 王浩杰[3] 李军[1] 

机构地区：[1]温州医科大学附属第二医院麻醉科,325027 [2]余姚市人民医院 [3]余姚市人民医院麻醉科

出　　处：《浙江医学》2014年第14期1248-1251,共4页Zhejiang Medical Journal

摘　　要：目的 比较McGrath-5型视频喉镜和Macintosh直接喉镜用于残齿老年患者气管插管的临床效果.方法 选取残齿老年全麻患者80例,ASAⅠ～Ⅲ级,按随机数字表法分为McGrath-5视频喉镜组（A组）和Macintosh直接喉镜组（B组）,各40例.观察患者在诱导前（T0）、诱导后2min（T1）、喉镜置入会厌谷即刻（T2）、导管进入声门即刻（T3）、插管后1 min（T4）、插管后3min（T5）、插管后5 min（T6）各时点的SBP、DBP及HR的变化.记录两组患者声门暴露分级、一次插管成功率和插管时间以及口腔黏膜、牙齿、牙龈损伤、咽痛和声嘶等并发症的发生率.结果 两组患者诱导后各时点的SBP、DBP及HR均较T0时点明显下降（P＜0.05）,B组T2时点HR明显低于A组（P＜0.05）.A组Cormack-Lehane分级中Ⅰ级、Ⅱ级者明显高于B组（P＜0.05）,一次插管成功率明显高于B组（P＜0.05）,插管时间明显短于B组（P＜0.05）,且插管损伤的并发症发生率也明显低于B组（P＜0.05）.结论 McGrath-5型视频喉镜用于气管插管,较Macintosh直接喉镜刺激小、暴露好、插管时间短,并发症少,适合在残齿老年患者中应用.Objective To compare the efficacy of McGrath-5 video laryngoscopy and Macintosh direct laryngoscopy for tracheal intubation in elderly patients with residual teeth. Methods Eighty elderly ASA grade Ⅰ - Ⅲ patients with residual teeth undergoing general anesthesia in our hospital from 2011 March to 2013 August, were randomly assigned to receive McGrath-5 video laryngoscopy （group A, n=40） or Macintosh laryngoscopy （group B, n=40） for tracheal intubation. Systolic blood pressure （SBP）, diastolic blood pressure （DBP） and heart rate （HR） changes were observed before induction （T0）, 2 min after induction （T1）, laryngoscope into vallecula （T2）, endotracheal tube into the glottis （T3）, 1 min （T4）, 3 min （Ts） and 5 min after intubation （T6）. Cormack-Lehane class, the successful rate of first intubation and intubation time were recorded. The incidence of complications including oral mucosa, teeth and gums injury, sore throat and hoarseness were also documented. Results SBP, DBP and HR at each time point after induction in two group decreased significantly compared with TO time point （P〈0.05）. HR at T2 was lower in group B than that in group A（P〈0.05）. Cormack-Lehane class in grade Ⅰ ＋ Ⅱ accounted 75% in group A, which was significantly higher than that in group B （50%, P〈0.05）. Intubation time in group A was significantly shorter than that in group B [19（10-62）s vs 31 （9-74）s, P〈0.05], the successful rate of first intubation in group A was significantly higher than that in group B （97.5% vs 87.5%, P〈0.05 ）, and the incidence of complications with intubation injury in group A was significantly lower than that in group B （30% vs 90%, P〈0.05）. Conclusion Compared with Macintosh laryngoscopy, McGrath-5 video laryngoscopy for endotracheal intubation has advantages of less irritation, better exposure, shorter intubation time and fewer complications, it is suitable for elderly patients with residual teeth.

关 键 词：McGrath-5视频喉镜 MACINTOSH直接喉镜 残齿患者 气管插管 并发症 

分 类 号：R614[医药卫生—麻醉学]