Airtraq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视频喉镜组和Macintosh直接喉镜组,每组20例。方法：麻醉诱导后分别使用Airtraq视频喉镜和Macintosh直接喉镜显露声门行气管插管。Airtraq视频喉镜组选择普通型的Airtraq视频喉镜,置入内径为8.0的气管导管。Macintosh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1min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1,2minMacintosh直接喉镜组心率、二重指数显著高于Airtraq视频喉镜组（P〈0.05）。结论：与Macintosh直接喉镜相比,应用Airtraq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 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 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 patients scheduled for surgery under general anesthesia requiring orotracheal intubation were randomly divided into Airtraq taryngoscope group and Macintosh laryngoscope group, with 20 cases in each group.
METHODS： After standard intravenous anesthetic induction, orotracheal intubation was performed with Airtraq laryngoscope or Macintosh laryngoscope. Common Airtraq laryngoscope was used in the Airtraq 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 laryngoscope group was significantly longer than that in Macintosh laryngoscope group （P 〈 0.01 ）, while the tracheal intubation time in Airtraq laryngoscope group was significantly shorter than that in Macintosh laryngoscope group （P 〈 0.01）. Compared with pre-induction （TO）, 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 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 laryngoscope group （P 〈 0.05）.
CONCLUSION： In comparison to the Macintosh laryngoscope, tracheal intubation with the Airtraq laryngoscope resulted in less alterations in hemodynamical responses.