麻醉规培医师应用视频喉镜对困难气道患者行气管插管研究  

Study of Standardized Training Anesthetic Residents Doctor Used Video Laryngoscopy for Endotracheal Intubation in Patients with Difficult Airway

作　　者：沈佳洋 杨清春 高海鹰[1,2] 王庆祥[1,2] 萧燕芳 林瑾 蒋晟 冯宇峰[1,2] SHEN Jiayang;YANG Qingchun;GAO Haiying;WANG Qingxiang;XIAO Yanfang;LIN Jin;JIANG Sheng;FENG Yufeng(The First Affiliated Hospital of Xiamen University Fujian,Province Anesthesiology Department Resident Doctor Standardization Training Base,Xiamen 361003,China;不详)

机构地区：[1]厦门大学附属第一医院福建省麻醉科住院医师规范化培训基地,福建厦门361003 [2]厦门大学附属第一医院(福建医科大学临床医学部福建中医药大学临床医学部麻醉教研室)

出　　处：《中国医学创新》2021年第11期169-173,共5页Medical Innovation of China

基　　金：福建省省卫计委青年课题(2015-2-42)。

摘　　要：目的:探讨麻醉规培医师应用视频喉镜(video-laryngoscopy,VL)在喉头显露Ⅲ、Ⅳ级的全麻患者行气管插管的效果及插管教学中的作用。方法:选取2017年1月-2019年12月于本院直接喉镜(direct laryngoscopy,DL)暴露声门Cormack-Lehane显示Ⅲ、Ⅳ级的80例手术患者,按照随机数字表法分为VL组和DL组,各40例。分别由熟练运用两种喉镜的麻醉规培医师进行气管插管,VL组在视频喉镜下实施气管插管,插管2次失败由指导老师插管;DL组在直接喉镜下实施气管插管2次失败,则改为视频喉镜下气管插管。比较两组总插管成功率、插管成功者的插管时间、首次插管成功率及咽喉黏膜损伤出血、咽痛、声嘶等并发症的发生率。结果:VL组总插管成功率高于DL组,插管成功者插管时间短于DL组,首次插管成功率明显高于DL组,咽喉黏膜损伤出血、咽痛、声嘶的发生率均低于DL组,差异均有统计学意义(P<0.05)。结论:在麻醉教学中,麻醉规范化培训住院医师将视频喉镜用于喉头显露Ⅲ、Ⅳ级患者气道管理效果明显,气管插管用时短,成功率高,伴随并发症少;VL对气管插管教学具有指导作用。Objective:To investigate the effect of standardized training anesthetic residents doctor used video-laryngoscopy(VL)for endotracheal intubation in the patients with larynx exposureⅢ,Ⅳgrade and grade general anesthesia and the role of intubation teaching.Method:From January 2017 to December 2019 in our hospital 80 surgical patients direct laryngoscopy(DL)exposed the glottis Cormack-Lehane displayⅢ,Ⅳgrade were selected,according to random number table method,they were divided into VL and DL group,40 cases in each group.Tracheal intubation was performed by anesthesiologists who were skilled in using the two kinds of laryngoscope,tracheal intubation was performed under video laryngoscope in the VL group,if the intubation failed twice,the instructor intubated the tube;in the DL group,tracheal intubation under direct laryngoscope failed for 2 times,so it was changed to tracheal intubation under video laryngoscope.The total success rates of intubation,intubation time,the success rate with first intubation and the incidence of complications such as pharyngeal mucosa injury and bleeding,pharyngalgia,hoarseness of patients with successful intubation were compared between the two groups.Result:The total success rate of intubation in the VL group was higher than that in the DL group,the duration of intubation of patients with successful intubation in the VL group was shorter than that in the DL group,the success rate of first intubation was significantly higher than that in the DL group,the incidence of bleeding of laryngopharyngeal mucosa injury,sore throat and hoarseness were lower than those in the DL group,the differences were statistically significant(P<0.05).Conclusion:In anesthesiology teaching,standardized training anesthetic residents doctor use VL for the airway management of patients with larynx exposureⅢ,Ⅳgrade,with short time of endotracheal intubation,high success rate and fewer accompanying complications.VL plays a guiding role in endotracheal intubation teaching.

关 键 词：麻醉 规范化培训 住院医师 视频喉镜 教学 气管插管 困难气道 

分 类 号：R-4[医药卫生] C975[经济管理—劳动经济]