老年患者明视插管软镜与Macintosh直接喉镜经口气管插管效果比较  

Comparison of orotracheal intubation with video intubationscope and Macintosh direct laryngoscope in elderly patients

作　　者：卢增停[1] 涂泽华 张康聪 胡浩翔 何绮桃[1] 林霭婷[1] 曾丽蓉[1] 

机构地区：[1]南方医科大学附属小榄医院麻醉科,广东中山528415

出　　处：《海南医学》2017年第3期408-411,共4页Hainan Medical Journal

摘　　要：目的比较明视插管软镜与Macintosh直接喉镜在老年患者经口气管插管中的应用效果。方法 2015年10月至2016年3月在我院行择期手术老年患者60例,ASAⅠ~Ⅱ级,年龄60~79岁,采用随机数表法分为明视插管软镜组(V组)和Macintosh直接喉镜组(M组),每组30例。V组采用明视插管软镜,M组采用Macintosh直接喉镜行经口气管插管。记录两组患者Cormark-Lehane镜下分级(C-L分级)、气管插管时间、气管插管成功情况及不良反应。记录麻醉诱导前(T1)、声门显露时(T2)、插管后即刻(T3)、插管后1 min(T4)和插管后3 min(T5)时的平均动脉压(MAP)和心率(HR)。结果与M组比较,V组声门显露情况(C-L分级)更优,气管插管时间V组明显短于M组[(22±10)s vs(32±11)s],差异均有统计学意义(P<0.05);V组气管插管一次成功29例,两次成功1例,一次插管成功率为96.7%,M组气管插管一次成功26例,两次成功4例,一次插管成功率为86.7%。两组一次气管插管成功率比较差异无统计学意义(P>0.05)。与T1时比较,V组MAP在T3时明显升高,HR在T3~T4时明显增快,M组MAP在T2~T5时明显升高,HR在T2~T4时明显增快。M组较V组在T2~T5时MAP显著升高、在T2~T4时HR显著增快,差异均有统计学意义(P<0.05或0.01);V组咽喉痛发生率为6.7%,明显低于M组的26.7%,差异有统计学意义(P<0.05)。结论与Macintosh直接喉镜比较,明视插管软镜在老年患者经口气管插管中显著改善了声门显露,明显降低了气管插管的难度,缩短了插管时间,插管并发症少,且对血流动力学影响较轻。Objective To compare the clinical application of orotracheal intubation with video intubationscope and direct laryngoscope in elderly patients.Methods Sixty American Society of Anesthesiology（ASA） Ⅰ or Ⅱ elderly patients,aged 60~79 years,who admitted to our hospital from October 2015 to March 2016,undergoing surgery under general anesthesia were randomly divided into the video intubationscope group（Group V） and the Macintosh direct laryngoscope group（group M）,with 30 cases in each group.Orotracheal intubation was respectively performed with video intubationscope（Group V） and Macintosh direct laryngoscope（group M）.Cormark-Lehane grade（C-L classification）,tracheal intubation time,intubation success and adverse reaction were recorded.Mean arterial pressure（MAP） and heart rate（HR） of before induction of anesthesia（T1）,at glottic exposure（T2）,at intubation（T3）,1 min after intubation（T4）and 3 min after intubation（T5） were recorded.Results Compared with group M,better glottic exposure view（C-L classification） was achieved in group V（P〈0.05）,and tracheal intubation time in group V was significantly shorter than that in the group M,（22±10） s vs（32±11） s,P〈0.05.In group V,29 cases were intubated on the first attempt,1 on the second,and the one-time success rate of intubation was 96.7%;in group M,26 cases were intubated on the first attempt,4 on the second,and the one-time success rate of intubation was 86.7%;there was no significant difference in the one-time success rate of tracheal intubation between the two groups（P〈0.05）.Compared with T1,MAP was obviously higher at T3 and HR was obviously faster at T3-T4 in group V;MAP was obviously higher at T2-T5 and HR was obviously faster at T2-T4 in group M（P〈0.05）.Compared with group V,MAP in group M was significantly higher at T2-T5（P〈0.05 or0.01） and HR in group M was significantly faster at T2-T4（P〈0.01）.The incidence of sore throat in group V was 6.7%,which was significantly

关 键 词：插管法 明视插管软镜 MACINTOSH直接喉镜 老年 

分 类 号：R767[医药卫生—耳鼻咽喉科]