可视喉镜与可视可塑型光棒在鼻咽癌放射治疗后患者气管插管的临床应用效果比较  

Clinical efficacy of visual laryngoscope versus visual mouldable light bar for tracheal intubation in patients with nasopharyngeal carcinoma after radiotherapy

作　　者：刘卫卫 徐睿 贾继娥 乔晖 王圣钰 夏莹 陆艺 LIU Weiwei;XU Rui;JIA Ji’e;QIAO Hui;WANG Shengyu;XIA Ying;LU Yi(Department of Anesthesiology,Eye&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：《上海医学》2024年第5期280-283,共4页Shanghai Medical Journal

基　　金：上海市科学技术委员会科技计划项目(21Y11900400)。

摘　　要：目的比较可视喉镜与可视可塑型光棒在鼻咽癌放射治疗(简称放疗)后患者气管插管中的临床应用效果。方法选择自2019年10月—2021年5月在复旦大学附属眼耳鼻喉科医院行择期气管插管全身麻醉下坏死组织清除术或颈淋巴结清扫术的鼻咽癌患者60例,年龄范围18~60岁。采用随机数字表法,将患者随机分为两组,分别使用可视喉镜(可视喉镜组)、可视可塑型光棒(可视可塑型光棒组)进行气管插管,每组各30例。比较两组患者的一般资料(包括年龄、性别构成、BMI、张口度、Mallampati分级、甲颏距离),总插管成功率、第1次插管成功率、气管插管时间,麻醉诱导前(T_(0))、诱导后即刻(T_(1))、气管插管后即刻(T_(2))和插管后3 min(T_(3))时的血流动力学指标[心率、平均动脉压(MAP)],以及插管相关并发症(牙龈渗血、上唇出血、咽喉部渗血、呛咳、口咽部损伤、牙齿脱落、支气管痉挛)。结果两组间患者的年龄、性别构成、BMI、张口度、Mallampati分级构成、甲颏距离的差异均无统计学意义(P值均>0.05)。可视可塑型光棒组总插管成功率显著高于可视喉镜组(P<0.05),但气管插管时间显著长于可视喉镜组(P<0.05)。可视可塑型光棒组的第1次插管成功率有高于可视喉镜组的趋势,但差异无统计学意义(P>0.05)。两组T_(2)时间点的心率和MAP均显著高于同组T0时间点(P值均<0.05),可视可塑型光棒组T_(2)时间点的心率显著低于可视喉镜组同时间点(P<0.05)。可视喉镜组牙龈渗血发生率显著高于可视可塑型光棒组(P<0.05),两组间上唇出血和咽喉部渗血发生率的差异均无统计学意义(P值均>0.05)。结论使用可视可塑型光棒对鼻咽癌放疗后患者行气管插管时口咽部损伤和血流动力学影响均较小;但使用可视喉镜行气管插管的时间较短,更有利于观察患者的声门水肿情况和评估拔管安全。Objective To compare the clinical efficacy of visual laryngoscope with visual mouldable light bar in tracheal intubation in patients with nasopharyngeal cancer after radiotherapy.Methods Sixty nasopharyngeal cancer patients aged 18-60 years who underwent elective necrotic tissue debridement or cervical lymph node dissection under general anesthesia with tracheal intubation from October 2019 to May 2021 at Eye&ENT Hospital of Fudan University were selected.They were randomly divided into visual laryngoscope group and visual mouldable light bar group(n=30)according to random number table method.The general information(age,gender composition,BMI,mouth opening,Mallampati classification,nail-chin distance),overall success rate of intubation,success rate of intubation at the first attempt,time of tracheal intubation,haemodynamic indexes(heart rate and mean arterial pressure[MAP])before induction of anesthesia(T_(0)),immediately after induction(T_(1)),immediately after tracheal intubation(T_(2))and 3 min after intubation(T_(3))were compared between the two groups.Intubation-related complications(gingival oozing,upper lip bleeding,pharyngeal oozing,choking,oropharyngeal injury,tooth loss,and bronchospasm)were recorded.Results There were no significant differences in the age,gender composition,BMI,mouth opening,Mallampati classification or nail-chin distance between the two groups(all P>0.05).The overall success rate of intubation in the visual mouldable light bar group was significantly higher than that in the visual laryngoscope group(P<0.05).The time of tracheal intubation in the visual mouldable light bar group was significantly longer than that in the visual laryngoscope group(P<0.05).The success rate of intubation at the first attempt in the visual mouldable light bar group was slightly higher than that in the visual laryngoscope group,but the difference was not statistically significant(P>0.05).The heart rate and MAP at T_(2) were significantly higher than those at T_(0) in the same group(all P<0.05).The heart rate

关 键 词：可视喉镜 可视可塑型光棒 困难气道 

分 类 号：R614.2[医药卫生—麻醉学]