Shikani可视喉镜与Mc Coy喉镜对气管插管应激反应影响的比较  

The comparative study of Shikani optical stylet and Mc Coy laryngoscope on stress responses to tracheal intubation

作　　者：孙怡[1] 龙瑞春[1] 赵国栋[1] 

机构地区：[1]广东省人民医院麻醉科,广州市510080

出　　处：《临床麻醉学杂志》2014年第11期1052-1055,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨全身麻醉诱导后采用Shikani可视喉镜（SOS）和Mc Coy喉镜（MCL）进行气管插管时的应激反应。方法选择择期手术的患者191例,ASAⅠ或Ⅱ级,随机分为SOS组（S组,n=99）和MCL组（M组,n=92）,每组中按声门暴露程度各分为三个亚组：S1组（n=34）、S2组（n=33）、S3组（n=32）和M1组（n=30）、M2组（n=30）、M3组（n=32）。静脉麻醉诱导后分别采用SOS（S组）和MCL（M组）实施经口气管插管操作。记录气管插管时间和麻醉诱导前（T0）、麻醉诱导后（T1）、插管后1min（T2）、3min（T3）、5min（T4）时的SBP、DBP、HR和Narcotrend指数（NI）,记录插管过程中芬太尼用量,并于T0、T2、T4时检测血糖。结果 M3组芬太尼用量明显多于S3组（P〈0.05）。M2组1次插管成功率明显低于S2组,M3组1次插管成功率明显低于S3组（P〈0.05）;T2、T4时M3组血糖明显高于T0时和S3组（P〈0.05）。T2~T4时M3组SBP、DBP明显高于,HR明显快于S3组（P〈0.05）。结论气管插管导致不同程度的应激反应,与MCL比较,SOS能有效减轻应激反应的程度,缩短插管时间,尤其在困难插管方面具有明显优势。Objective To compare the different effects of Shikani optical stylet（SOS）and Mc Coy laryngoscope（MCL）on stress responses to tracheal intubation in patients after anesthetic induction.Methods One hundred ninety-one patients with ASA gradeⅠ orⅡ and undergoing the elective surgery and requiring orotracheal intubation were randomly allocated to either group S（with SOS）or group M（with MCL）.Patients in each group were divided into three subgroups in relation to the laryngeal exposure difficulty by mallampati classification,groups S1（n=34）and M1（n=30）：soft palate,fauces,pillars and uvula could be visible,groups S2（n=33）and M2（n=30）：soft palate,fauces,pillars and uvula could be visible,Groups S3（n=32）and M3（n=32）：soft palate and base of uvula could be invisible.After standard intravenous anesthetic induction,orotracheal intubation was performed using a SOS or a MCL.The number of second-intubation and the dosage of fentanyl were written down.SBP,DBP,and HR were recorded before the induction of anesthesia（T0）,after the induction of anesthesia（T1）,and at 1min（T2）,3min（T3）and 5min（T4）after the tracheal intubation.Blood sugar was monitored at T0,T2 and T4.The index of Narcotrend was monitored at each time point.Results There were no significant difference on the index of Narcotrend bwteen the two groups at each time point.The dosage of fentanyl used in Group M3 was much more than in GroupS3（P〈0.05）.Comparing with group S3,there were more second-intubations and longer duration for intubation in group M3（P〈0.05）.The values of blood sugar in group M3 were significantly higher than that in group S3 at T2（P〈0.05）,and at T4 and the value of blood sugar was higher at T2 and T4than that at T0 in group M3（P〈0.05）.The hemodynamic indexes including SBP,DBP and HR of patients in group S3 were significantly lower than those in group M3 at T2-T4（P 0.05）.Conclusion A certain extent of stress response can be caused by tracheal intubation.Compari

关 键 词：Shikani可视喉镜 MC Coy喉镜 经口气管插管 应激反应 

分 类 号：R614[医药卫生—麻醉学]