GlideScope视频喉镜在困难气道经口气管插管中应用的评价

目的介绍GlideScope视频喉镜在经口困难气道气管插管中应用的经验,观察其可操作性、临床应用价值和需要注意的事项。方法21例术前评估为困难气道先应用Macintosh型直接喉镜插管失败的患者,ASAI～Ⅲ级。除2例采用清醒慢诱插管外,其余患者均采用快速诱导。Macintosh型直接喉镜插管失败后,采用GlideScope视频喉镜实施经口气管插管操作。分别记录采用Macintosh型直接喉镜和GlideScope视频喉镜喉部显露分级、气管插管操作时间和插管次数。结果采用GlideScope视频喉镜在所有患者获得的喉部显露分级均为I～Ⅱ级,采用Macintosh型直接喉镜在所有患者获得的喉部显露分级分别为Ⅱ级3例、Ⅲ级12例、Ⅳ级6例。气管插管操作时间采用GlideScope视频喉镜为（29±22）s。采用Macintosh型直接喉镜为（67±23）s。插管次数采用GlideScope视频喉镜17例为1次插管成功。4例为2次插管成功,采用Macintosh型直接喉镜插管次数为2—4次不等,均无法插入声门。结论作为一种新型气管插管工具,采用GlideScope视频喉镜实施经口气管插管操作具有喉部显露清晰、损伤小和可降低气管插管操作难度等优点,为解决临床气管插管困难问题提供了一种新的思路。

The clinical application of orotracheal intubation in difficult airway with GlideScope videolaryngoscope

Objective To introduce the clinical experience of the application of orotracheal intubation with GlideScope videolaryngoscope and observe its maneuverability, clinical application value and announcements. Methods 21 patients with ASA I - Ⅲ, including 12 male patients and 9 female patients, with difficulty for traditional tracheal intubation identified before operation, were difficult airway by predicting before operation. All the patients received rapid sequence induction of anesthesia except that two of them received slow sequence induction of anesthesia. The orotracheal intubation was done with Glide,Scope videolaryngoscope after failure of using Macintosh direct laryngoscope. The time of tracheal intubation, the nurnber of times of tracheal intubation and the Corrnack grading were recorded by using GlideScope videolaryngoscope and Macintosh direct laryngoscope. Results The incidence of successful orotraeheal intubation with GlideScope videolaryngoscope was 100%, while which was 0% in Macintosh direct laryngoscope. The Cormaek grading was grade I - Ⅱ in all patients with GlideScope videolaryngoscope, but the Cormaek grading was grade Ⅱ-Ⅳ in all patients with Macintosh direct laryngoscope. The times of tracheal intubation were （29 ±22 ） s and （67±23）s, respectively. The number of times of tracheal intubation were 1 in 17 patients and 2 in 4 patients with GlideScope videolaryngoscope , however, the number of times of tracheal intubation was 2 - 4 in all patients, and all tracheal intubation was failed with Macintosh direct laryngoscope. Conclusion The orotracheal intubation with GlideScope videolaryngoscope is a new manipulation with simplicity, easy performance, little injury and clear visualization for the glottis. Moreover, it may have some clinical value in dealing with difficult airway. Tile GlideScope videolaryngoscope is suitable to be used in clinic.