两种不同角度的McGrath喉镜行气管插管的对比研究  

Comparison of two types of McGrath videolaryngoscopes with different tracheal intubation angle

作　　者：郝小芳[1] 高学[1] 张梁[1] 崔凌利[1] 田鸣[1] HAO Xiao-fang;GAO Xue;ZHANG Liang(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China.)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《临床和实验医学杂志》2019年第9期952-956,共5页Journal of Clinical and Experimental Medicine

基　　金：首都医科大学附属北京友谊医院科研启动基金(编号:yyqdkt2018-12)

摘　　要：目的比较不同镜片角度的McGrath喉镜(McGrath Series 5和McGrath MAC)的声门显露程度、气管插管难易程度以及并发症发生情况。方法采用前瞻性研究方法,纳入2015年1月至2016年1月首都医科大学附属北京友谊医院收治的年龄> 18岁、美国麻醉医师协会分级(ASA)Ⅰ～Ⅲ级、需气管插管的、全身麻醉的、择期手术患者共160例,其中男性84例,女性76例。采用信封法将患者随机分为两组,McGrath-MAC组(MAC组):使用McGrath-MAC喉镜进行气管插管,McGrath-Series 5组(S5组):使用McGrath-Series 5喉镜进行气管插管,每组各80例。患者入室后连接多功能重症监护仪,持续监测心率(HR)、心电图(ECG)、无创血压(NIBP)、脉搏氧饱和度(Sp O_2),连接麻醉机并监测呼末二氧化碳。常规麻醉诱导,待肌松充分起效,首先使用Macintosh喉镜暴露声门并记录Cormack-Lehane分级(以下简称C-L分级),继续面罩通气1 min后再使用McGrath喉镜(MAC或Series 5)显露声门并记录最佳声门显露时的C-L分级,然后行气管插管,前2次插管不使用管芯,若2次均失败则使用Glide Scope管芯插管。记录各组分次试插管时间,总插管时间、插管次数、是否应用辅助管芯以及并发症发生情况。结果 MAC组和S5组患者的管芯使用率分别为23. 75%、83. 25%,差异具有统计学意义(P <0. 05);在不使用管芯的情况下,MAC组和S5组患者的一次插管成功率分别为71. 25%、16. 15%,差异具有统计学意义(P <0. 05); MAC组和S5组患者完成插管所需总时间分别为(35. 11±36. 41) s、(70. 4±30. 26) s,差异具有统计学意义(P <0. 05); MAC组和S5组McGrath喉镜下声门C-L分级达Ⅰ～Ⅱ级者分别为79例(98. 75%)、80例(100%),差异无统计学意义(P> 0. 05)。结论适当降低视频喉镜的镜片角度,可以做到不影响声门改善程度,并且能够提高插管的容易度。Objective To compare the differences between two types of Mc Grath video laryngoscope(Mc Grath Series 5 and Mc Grath MAC)in glottic exposure,complexity of tracheal intubation and complications.Methods This prospective study was conducted to enroll patients of above 18 years,ASA grade I to III,requiring tracheal intubation from January 2015 to January 2016 at our center.84 cases were male and 76 cases were female.Patients were randomized to two groups:group Mc Grath-MAC(MAC group)(n=80),group Mc Grath-Series 5(S5 group)(n=80).All patients were monitored after entering the operation room,including heart rate(HR),electrocardiogram(ECG),non-invasive arterial pressure(NIBP),and pulse oxygen saturation(SpO2),and end-tide carbon dioxide pressure(PETCO2).After induction of anesthesia and muscle relaxation,Macintosh laryngoscope was used to expose the glottic view and to record the classification of Cormack-Lehane.(C-L classification).Then Mc Grath videolaryngoscopes were used to expose the glottic view and record the best C-L classification after 1 min mask ventilation.During the tracheal intubation,stylet was forbidden in the first two attempts,unless the first two intubation attempts were failed.The duration of each intubation attempt was recorded and totaled.The number of intubation attempts,whether using stylet and the rate of complication were also recorded and analyzed.Results For group MAC and group S5,the rate of using stylet were 23.75%vs.83.25%(P<0.05);the rate of first successful tracheal intubation without stylet were 71.25%vs.16.15%(P<0.05);the total duration of successful tracheal intubation were(35.11±36.41)s vs.(70.4±30.26)s(P<0.05);the glottic view of C-L classificationⅠ~Ⅱwere 79(98.75%)and 80(100%)respectively(P>0.05).Group MAC can provide similar glottic exposure to group S5.Conclusion Mc Grath-MAC laryngoscope can reduce the lens front-end angle as much and ease intubation without compromise of exposure glottis.

关 键 词：视频喉镜 MACINTOSH喉镜 气管插管 并发症 

分 类 号：R614[医药卫生—麻醉学]