Airtraq(R)视频喉镜与Macintosh直接喉镜经口气管插管时的血流动力学比较

背景:常规使用Macintosh直接喉镜气管插管可引起强烈的血流动力学反应,从原理上讲,Airtraq(R)视频喉镜对咽喉刺激小,但两者对血流动力学影响的比较研究尚未见报道.目的:比较Airtraq(R)视频喉镜和Macintosh直接喉镜经口气管插管时的血流动力学反应.设计、时间及地点:随机对照观察,于2008-10/2009-04在大连市第二人民医院麻醉科完成.对象:40例拟经口气管插管全身麻醉下择期手术患者,按随机数字表法分为Airtraq(R)视频喉镜组和Macintosh直接喉镜组,每方法:麻醉诱导后分另.使用Airtraq(R)镜.Macintosh直接喉镜显露声门行气管插管.Airtraq(R)频喉镜组选择普的Airtraq(R)视频喉镜,置入内径为8.0的气管导管.Macintosh(R)直接喉镜组选用3号镜片,使用内径为8.0的气管导管.主要观察指标:声门显露时间、导管置入时间、麻醉诱导前、气管插管前、气管插管后即刻、气管插管后1,2,3min时的收缩压、舒张压、心率,计算各观察时点的二重指数.结果:Airtraq(R)视频喉镜组声门显露时间长于Macintosh直接喉镜组(P<0.01);导管置入时间Airtraq(R)视频喉镜组短于Macintosh直接喉镜组(P＜0.01).与麻醉诱导前相比,两组气管插管前收缩压、舒张压、二重指数均明显下降(P< 0.05),心率变化不明显(P> 0.05).与气管插管前相比,Airtraq(R)视频喉镜组插管时及插管后各时点血流动力学指标无明显变化(P>0.05),Macintosh直接喉镜组气管插管后2min时心率、二重指数,气管插管后即刻、气管插管后1 min收缩压、舒张压、心率和二重指数显著升高(P<0.05).气管插管后即刻、气管插管后1.2min Macintosh直接喉镜组心率、二重指数显著高于Airtraq(R)视频喉镜组(P<0.05).结论:与Macintosh直接喉镜相比,应用Airtraq(R)视频喉镜行经口气管插管患者血流动力学反应较轻.

Hemodynamical comparison between Airtraq. Laryngoscope and Macintosh laryngoscope for orotracheal intubation

BACKGROUND: Orotracheal intubation with conventional Macintosh laryngoscope often makes strong alterations in hemodynamic responses. Compare with the Macintosh laryngoscope, the Airtraq~((R)) laryngoscope has weak effect on throat irritation. However, the contrast effect on hemodynamics remains still unknown. OBJECTIVE: To compare the hemodynamical responses to orotracheal intubation between Airtraq~((R)) laryngoscope and Macintosh laryngoscope. DESIGN, TIME AND SETTING: A randomized comparative observation was performed at Department of Anesthesiology, Dalian Second People's Hospital between October 2008 and April 2009. PARTICIPANTS: A total of 40 patents scheduled for surgery under general anesthesia requiring orotracheal intubation were randomly divided into Airtraq~((R)) laryngoscope group and Macintosh laryngoscope group, with 20 cases in each group. METHODS: After standard intravenous anesthetic induction, orotracheal intubation was performed with Airtraq~((R)) laryngoscope or Macintosh laryngoscope. Common Airtraq~((R)) laryngoscope was used in the Airtraq~((R)) laryngoscope group, and an endotracheal tube with internal diameter of 8.0 was inserted. No. 3 lens were used in the Macintosh laryngoscope group, and an endotracheal tube with internal diameter of 8.0 was inserted. MAIN OUTCOME MEASURES: Glottic exposure time, tracheal intubation time, noninvasive heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) before (T0) and after (T1) anesthetic induction as well as at 0 minute (T2), 1 minute (T3), 2 minutes (T4), and 3 minutes (T5) after intubation, as well as rate-pressure product (RPP). RESULTS: The glottic exposure time in Airtraq~((R)) laryngoscope group was significantly longer than that in Macintosh laryngoscope group (P < 0.01), while the tracheal intubation time in Airtraq~((R)) laryngoscope group was significantly shorter than that in Macintosh laryngoscope group (P < 0.01). Compared with pre-induction (T0), the SBP, DBP, and RPP of the two groups decreased significantly after anesthetic induction (T1) (P < 0.05), but the HR did not change remarkably (P > 0.05). Compared with T1, all hemodynamical values at T2, T3, T4 and T5 in Airtraq~((R)) laryngoscope group did not increased sign ificantly (P > 0.05). In Macintosh laryngoscope group, HR and RPP at T4, SBP, DBP, HR and RPP at T2 and T3 increased significantly compared with T1 (P < 0.05). In Macintosh laryngoscope group, HR and RPP at T2, T3 and T4 were significant higher than that in Airtraq~((R)) laryngoscope group (P< 0.05). CONCLUSION: In comparison to the Macintosh laryngoscope, tracheal intubation with the Airtraq~((R)) laryngoscope resulted in less alterations in hemodynamical responses.