不同类型喉镜在颈髓损伤患者全麻气管插管中的效果观察  

Clinical effects of different kinds of laryngoscope in tracheal intubation under general anesthesia in treatment of cervical spinal cord injury

作　　者：孙继芬[1] 何芳[2] SUN Jifen;HE Fang(Department of Health Surveillance,Hygienic and Antiepidemic Station,Beijing Railway Bureau,Beijing 100038,China)

机构地区：[1]北京铁路局中心卫生防疫站卫生监测科,北京市100038 [2]中国医科大学附属第四医院麻醉科

出　　处：《河北医药》2018年第10期1497-1500,共4页Hebei Medical Journal

摘　　要：目的观察不同类型的喉镜应用于颈髓损伤患者气管插管全麻的临床效果。方法选取接受全麻气管插管的颈髓损伤患者120例,计算机将其随机分为Shikani硬质喉镜组(A组)、Glide Scope视频喉镜组(B组)、Mc Grath-5型视频喉镜组(C组)以及Macintosh直接喉镜组(D组),每组30例。观察这4组患者在暴露声门时和插管后颈椎的曲度变化;在插管即刻(T1)、插管后1 min(T2)、插管后3 min(T3)、插管后5 min(T4)的血氧饱和度(SPO2)、心率(HR)和平均动脉压(MAP)的变化;插管的成功率以及所需时间;术后并发症的发生情况。结果 B、C组患者在暴露声门时和插管后颈椎的曲度变化要小于D组(P<0.05),B、C组之间的变化无统计学差异(P>0.05),A组患者在暴露声门时和插管后颈椎的曲度变化要小于B、C组(P<0.05);4组患者的T1到T4时间的SPO_2均无显著变化(P>0.05),B、C组T3到T4点MAP和HR变化均要低于D组(P<0.05),B、C组间差异无统计学意义(P>0.05),A组T3到T4点MAP和HR变化均要低于B、C组(P<0.05);A组的一次插管成功率大于B、C组(P<0.05),B、C组的一次插管成功率大于D组(P<0.05),B、C组间差异无统计学意义(P>0.05);A组的插管成功所需时间小于B、C组(P<0.05),B、C组插管成功所需时间小于D组(P<0.05),B、C组间差异无统计学意义(P>0.05);4组术后的并发症发生情况差异无统计学意义(P>0.05)。结论对于颈髓损伤患者气管插管而言,Shikani硬质喉镜一次插管成功率高,对患者损伤小,安全性较高,值得临床推广。Objective To observe the clinical effect of different kinds of laryngoscope in tracheal intubation under general anesthesia in treatment of cervical spinal cord injury. Methods A total of 120 patients with cervical spinal cord injury were randomly divided into group A（ Shikani laryngoscope,n = 30）,group B（ Glide Scope video aryngoscope,n = 30）,group C（ Mc Grath5 video-laryngoscope,n = 30） and group D（ Macintosh direct laryngoscope,n = 30）. The curvature changes of cervical vertebra when glottis was exposed were observed and compared among the four groups. In addition,the levels of oxygen saturation,heart rate and mean arterial pressure at different time points were observed and compared. The success rate,intubation time and incidence rate of complication after surgery were also observed and compared among the four groups. Results The curvature changes of cervical vertebra when glottis was exposed and after tracheal intubation in group B and group C were significantly lower than those in group D,which were significantly higher than those in group A（ P〈 0. 05）,however,there were no significant differences between group B and group C（ P 〉0. 05）. The curvature changes of cervical vertebra in group A were less than those in group B and group C（ P 〉0. 05）. There was no significant change in levels of SPO2 from T1 to T4 in the four groups（ P 〉0. 05）. The changes of MAP and HR in group B and group C were less than those in group D（ P〈 0. 05）,and there were no significant differences between group B and group C（ P〉 0. 05）. The changes of MAP and HR in group A were less than those in group B and group C（ P〈 0. 05）. The success rate in once intubation in group B and group C was significantly lower than that in group A（ P 〈0. 05）,however,which was significantly higher than that in group D（ P〈 0. 05）,there was no significant difference between group B and group C（ P 〉0. 05）. The intubation time in group B and group C was longer than that in group A（

关 键 词：颈髓损伤 麻醉 气管插管 喉镜 

分 类 号：R614[医药卫生—麻醉学]