GlideScope视频喉镜、直接喉镜和光导纤维支气管镜经鼻气管插管时血流动力学反应的比较

目的比较采用GlideScope视频喉镜(GSVL)、Macintosh型直接喉镜(MDLS)和光导纤维支气管镜(FOB)实施经鼻气管插管时的血流动力学反应。方法将美国麻醉医师协会(ASA)身体状况分级为Ⅰ~Ⅱ级、年龄18~50岁、拟在经鼻气管插管全身麻醉下施择期整形外科手术的60例患者随机分为GSVL组、MDLS组和FOB组,每组20例。常规麻醉诱导后,分别采用GSVL、MDLS或FOB实施经鼻气管插管操作。观察记录麻醉诱导前基础值、麻醉诱导后值,气管插管时和气管插管后5min内每间隔1min的血压(BP)和心率(HR),并记录观察期BP、HR的最大值和最小值,计算各时间点的心率收缩压乘积(RPP)。以时间为横坐标及观察期BP和HR的变化为纵坐标计算气管插管后观察期血流动力学时-效关系曲线下面积(AUE)。结果3组的基本情况和气管插管时间差异无显著性。麻醉诱导后3组的BP和RPP较基础值显著降低(P<0.05),而HR无显著性变化。经鼻气管插管导致3组的BP、HR和RPP较麻醉诱导后值显著升高(P<0.05)。与基础值相比,气管插管时FOB组的BP、HR和RPP均显著升高(P<0.05),MDLS组气管插管时的HR以及观察期舒张压、平均动脉压、HR和RPP的最大值显著升高(P<0.05),但GSVL组气管插管时和气管插管后的各项血流动力学指标与基础值差异均无显著性。FOB组气管插管时的各项血流动力学指标和观察期HR>100bpm的发生率显著高于GSVL组和MDLS组(P<0.05);虽然观察期的BP在MDLS组和GSVL组之间差异无显著性,但MDLS组气管插管时和气管插管后的HR和RPP以及AUEHR显著高于GSVL组(P<0.05)。GSVL组的AUEHR和AUESBP显著低于FOB组(P<0.05)。结论实施经鼻气管插管时的血流动力学反应在采用FOB时最强,MDLS次之,GSVL最轻。

Comparison of hemodynamic responses to nasotracheal intubations with Glide Scope video-laryngoscope, Macintosh direct laryngoscope, and fiberoptic bronchoscope

OBJECTIVE: To compare the hemodynamic responses to nasotracheal intubation with GlideScope videolaryngoscope (GSVL), Macintosh direct laryngoscope (MDLS), and fiberoptic bronchoscope (FOB). METHODS: Sixty patients, with American Society of Anesthesiologists (ASA) physical status I - II, aged 18- 50 years, and scheduled for elective plastic surgery under general anesthesia requiring nasotracheal intubation, were randomly allocated equally to GSVL group, MDLS group, and FOB group. After the routine anesthesia induction, nasotracheal intubation was performed with the GSVL, MDLS, and FOB, respectively. Noninvasive blood pressure (BP) and heart rate (HR) were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation, and subsequently at an interval of every 1 minute for a total of five minutes. The maximum and minimum values of BP and HR during the observation period were also noted. The rate pressure product (RPP) at each measuring time point was calculated. The areas under effect-time curve (AUE) of hemodynamics were calculated by time as X-axis and changes of BP and HR during the observation as Y-axis. RESULTS: All the three groups were similar in the demographic data and intubation time. After anesthesia induction, BP and RPP in all the three groups decreased significantly compared to baseline values (P < 0. 05), while HR had no significant change. After nasotracheal intubation, BP, HR, and RPP in all three groups were significantly higher than the postinduction values (P < 0.05). In the FOB group, BP, HR, and RPP at intubation significantly increased when compared with the baseline values (P < 0.05). In the MDLS group, HR at intubation, and maximum values of diastolic blood pressure (DBP), mean arterial pressure (MAP), HR, and RPP during the observation were significantly higher than the baseline values (P < 0.05). In the GSVL group, all hemodynamic parameters at intubation and after intubation were not significantly different from the baseline values. BP, HR, and RPP at intubation, and the incidences of HR more than 100 bpm during the observation were significantly higher in the FOB group than in the other two groups (P < 0.05). BP was not significantly different during the observation between the MDLS and GSVL groups, but HR and RPP at intubation and after intubation as well as AUE(HR) were significantly higher in the MDLS group than in the GSVL group (P < 0.05). AUE(HR) and AUE(SBP) were significantly lower in the GSVL group than in the FOB group (P < 0.05). CONCLUSION: The hemodynamic responses to nasotracheal intubation are most severe with FOB, followed by MDLS, and then GSVL.