Glidescope视频喉镜联合Disposcope内窥镜在高危型会厌囊肿患者气管插管中的应用  

Application of Glidescope video laryngoscope combined with Disposcope endoscope in endotracheal intubation in patients with high-risk epiglottic cysts

作　　者：李杰 李卫星 汪鼎鼎 LI Jie;LI Wei-xing;WANG Ding-ding(Department of Anesthesiology,E&ENT Hospital of Fudan University,Shanghai 200031,CHINA)

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031

出　　处：《海南医学》2020年第10期1252-1255,共4页Hainan Medical Journal

基　　金：上海市科委科技创新行动计划(编号:1744190300)。

摘　　要：目的探讨Glidescope视频喉镜与Disposcope内窥镜联合使用在高危型会厌囊肿患者气管插管中的应用价值。方法选取于2017年5月至2019年8月在复旦大学附属眼耳鼻喉科医院行手术治疗的高危型会厌囊肿患者60例,采用区组随机化分组法分为Glidescope视频喉镜与Disposcope内窥镜组(GD组) 30例和纤维支气管镜组(FOB组) 30例。术前常规麻醉诱导,分别使用纤维支气管镜和Glidescope视频喉镜与Disposcope内窥镜联合使用进行气管插管。记录插管成功率(包括一次插管成功率以及总的插管成功率),气管插管时间,插管前(T1)、气管导管放置到位(T2)以及插管完成后2 min (T3)的生命体征,术中由耳鼻喉科医生评估是否有会厌囊肿损伤和咽部黏膜损伤,术后24 h评估患者咽痛、声嘶等并发症。结果两组患者一般情况和插管前气道评估,包括囊肿最大径、甲颏距离、张口度和改良Mallampati分级比较差异均无统计学意义(P>0.05);两组患者的总插管成功率均为100%;GD组患者的插管时间为(1.3±0.4) min,明显短于FOB组的(3.2±2.0) min,一次插管成功率为96.7%,明显高于FOB组的73.3%,差异均有统计学意义(P<0.05);插管时氧饱和度分别为GD组(95.1±1.82)%和FOB组(95.2±1.79)%,差异无统计学意义(P>0.05);GD组患者的平均动脉压为(80.1±6.7) mmHg,明显低于FOB组的(83.8±6.3) mmHg,差异有统计学意义(P<0.05);两组患者的心率、囊肿损伤发生率和黏膜损发生伤率比较差异均无统计学意义(P>0.05);术后随访,FOB组和GD组患者的咽痛发生率分别为50.0%、26.7%,声嘶发生率分别为26.7%、10.0%,差异均无统计学意义(P>0.05)。结论 Glidescope视频喉镜联合Disposcope内窥镜用于高危型会厌囊肿患者气管插管相较于纤维支气管镜,插管时间缩短,一次成功率更高,插管时生命体征更加平稳,是解决高危型会厌囊肿气管插管的一种选择。Objective To evaluate the clinical value of Glidescope video laryngoscope combined with Disposcope endoscope in endotracheal intubation of patients with high-risk epiglottic cysts. Methods From May 2017 to August 2019, 60 patients with high-risk epiglottic cyst who underwent surgical treatment in E&ENT Hospital of Fudan University were selected and randomly divided into two groups by block random grouping method: Glidescope video laryngoscope and Disposcope endoscope group(GD group, 30 cases) and fiberoptic bronchoscopy group(FOB group, 30 cases). Fiberoptic bronchoscopy and Glidescope video laryngoscope combined with Disposcope endoscope were used to perform endotracheal intubation. The success rate of intubation(including the success rate of primary intubation and the total success rate of intubation), the time of endotracheal intubation, the vital signs before intubation(T1), at the time of the endotracheal tube was placed in place(T2) and 2 min after intubation(T3) were recorded. During the operation,the otolaryngologist evaluated whether there was epiglottic cyst injury and pharyngeal mucosal injury. Complications such as pharyngeal pain and hoarseness were evaluated 24 h after surgery. Results There was no statistically significant difference between the two groups in the general condition and the assessment of the airway before intubation, including the maximum size of the cyst, the mandible distance, the degree of mouth opening, and the modified Mallampati classification(P>0.05). The total success rate of intubation in both groups was 100%. The intubation time of GD group was(1.3±0.4) min, significantly shorter than(3.2±2.0) min of FOB group, and the success rate of the first intubation was 96.7%, significantly higher than 73.3% of FOB group, with statistically significant differences(P<0.05). Oxygen saturation during intubation was(95.1±1.82)% in GD group and(95.2±1.79)% in FOB group, with no statistically significant difference(P>0.05). The mean arterial pressure in GD group was(80.1±6.7) mmHg, whi

关 键 词：GLIDESCOPE视频喉镜 Disposcope内窥镜 纤维支气管镜 全身麻醉 会厌囊肿 气管插管 

分 类 号：R653[医药卫生—外科学]