Shikani与Macintosh两种喉镜在胸科手术患者双腔支气管插管中的比较

目的:比较Shikani喉镜和Macintosh喉镜,在胸科手术患者双腔支气管插管的临床效果。方法:选择需行单肺通气的胸外科手术患者60例,随机均分为两组,Shikani喉镜组(S组)和Macintosh喉镜组(M组)各30例。麻醉诱导后分别采用Shikani喉镜或Macintosh喉镜,实施经口双腔支气管插管操作。记录并比较麻醉诱导前(T1)、气管插管前(T2)、气管插管后即刻(T3)、气管插管后5 min(T4)的平均动脉压(MAP)值、心率(HR)值和脑电双频指数(BIS)值。观察比较2组插管时间、置入目标支气管的成功率及口腔损伤出血情况。结果:在T3点,M组患者的平均动脉压(MAP)和心率(HR)均明显高于S组患者(P<0.05),其余各时间点两组患者的血流动力学指标,差异均无统计学意义。各点脑电双频指数(BIS)值,两组间比较差异均无统计学意义。S组患者的插管时间明显相似文献   

Airtraq可视喉镜在困难气道全麻患者气管插管中的应用

目的观察应用Airtraq可视喉镜对困难气道患者全麻中行气管插管的临床效果。方法选择拟经口气管插管全身麻醉下实施择期手术的困难气道患者60例,MallampatisⅢ～Ⅳ级,随机分为Airtraq组、Macintosh组,每组各30例。两组均采用慢诱导气管插管,诱导后分别采用Airtraq可视喉镜及Macintosh喉镜进行气管插管操作,比较两组气管插管一次成功率、插管时间和麻醉诱导前（T1）、诱导后（T2）、气管插管后即刻（T3）及气管插管后3 min（T4）的HR、SBP、DBP,观察两组声门暴露及并发症情况。结果 Airtraq组气管插管一次成功率高于Macintosh组,插管时间短于Macintosh组,T3、T4时HR、SBP、DBP低于Macintosh组,并发症发生率低于Macintosh组（P均〈0.05）。Airtraq组Ⅰ级气管插管声门暴露的比例高于Macintosh组（P〈0.05）。结论 Airtraq可视喉镜具有快速、声门暴露好、气管插管时血流动力学变化幅度小、插管损伤小的优点,适合于困难气道患者的气管插管。     

I-gel喉罩辅助纤维支气管镜引导经口气管插管对全麻手术患者血流动力学的影响

目的观察I-gel喉罩辅助纤维支气管镜(FOB)引导经口气管插管对全麻手术患者血流动力学的影响。方法将40例择期全麻手术患者随机分为M组和O组各20例,常规麻醉诱导后,M组采用Macintosh直接喉镜经口气管插管,O组采用I-gel喉罩辅助FOB引导经口气管插管。观察麻醉插管不同时间点血压(BP)和心率(HR)、喉部暴露情况的Cormack/Lehane(C/L)分级、插管时间,并计算收缩压(SBP)与HR乘积(RPP)。结果 O组C/L分级为(1.30±0.47)级,低于M组的(1.80+0.62)级(P<0.01)。O组气管插管时间为(74.2±11.1)s,建立有效气道通气时间为(18.2±4.9)s,M组分别为(34.4±10.5)、(34.4±10.5)s,两组比较,P均<0.01。两组诱导后的BP、HR和RPP值均较诱导前的基础值下降(P均<0.05),插管即刻和气管插管后3 min内BP、HR和RPP较诱导后增高(P均<0.05),但O组插管即刻和气管插管后1 min的BP、HR和RPP比M组低(P均<0.05),且M组气管插管后4 min的BP、HR和RPP较诱导后仍较高(P均<0.05)。结论 I-gel喉罩辅助FOB引导经口气管插管对全麻手术患者血流动力学的影响轻于Macintosh直接喉镜气管插管。     

Glide Scope图视喉镜、普通直接喉镜经口气管插管时应激反应的比较

将40例拟经口气管插管的全麻患者随机分为Glide Scope图视喉镜组（A组）和Macintosh喉镜组（B组）,记录两组心率（HR）、动脉收缩压（SBP）、动脉舒张压（DBP）的基础值（To）和诱导前（T1）、插管时（T2）及插管后1（T3）、3（T4）、5（T5）min的数值;并于T0、T4、T5检测血浆肾上腺素（E）、去甲肾上腺素（NE）浓度。发现A组T2、T3时及B组T2、L、T4时HR、SBP、DBP均较T0时升高,A组T2、T3时SBP、DBP及T4、T5时的血浆E、NE浓度均较B组相同时点低。认为使用Glide Scope图视喉镜经口气管插管引起的应激反应明显低于普通喉镜。     

GlideScope视频喉镜在气管插管患者的临床运用

GlideScope视频喉镜为一种新型视频气管插管器械,前端安装有高清晰度微型摄像头,通过纤维光缆传递,咽部结构可以被清晰放大到显示器上.摄像头距镜片前端仅3cm,避免了舌咽部结构对声门的阻挡,使声门结构清晰可见.另外,其镜片厚度仅为1.8cmn,并且前端弯曲60度,有利于声门显露及气管插管操作,可以减少对咽喉部的刺激和减轻血流动力学影响.我们对本院呼吸重症监护病房需经口气管插管患者分别使用GlideScope视频喉镜和直接喉镜进行气管插管进行比较.     

经鼻或口气管插管和气管切开在呼吸衰竭患者中的应用探讨

目的研究经鼻或口气管插管和气管切开在呼吸衰竭患者中的治疗效果。方法128例呼吸衰竭患者随机分为A（48例）、B（40例）、C（40例）三组,A组患者经鼻气管插管,B组患者经口气管插管,C组患者行气管切开,观察三组患者治疗前后血气变化、置管时间、肺部感染等情况。结果三组呼吸衰竭患者血气改善时间和血气变化无显著差异,但是A组具有置管时间短、肺部感染少和降低了死亡率等优点。结论经鼻气管插管对呼吸衰竭患者有更好的临床应用价值,安全有效,值得临床推广应用。     

可视喉镜在困难气管插管中的应用价值

目的探讨视可尼可视喉镜(SOS)在困难气管插管中的应用价值。方法 54例拟行困难气管插管患者随机分为2组,S组(n=27例)采用视可尼可视喉镜行气管插管,M组(n=27例)采用Macintoch直接喉镜行气管插管。监测两组患者诱导前、插管开始时和插管完成时的平均动脉压(MAP)和心率(HR),并记录插管时间和插管相关并发症。结果与诱导前比较,插管开始时两组患者MAP、HR均明显降低(P<0.05);插管完成时M组MAP、HR较S组明显升高(P<0.05);S组插管时间明显短于M组(P<0.05);S组插管后并发症发生率明显低于M组(P<0.05)。结论视可尼可视喉镜用于困难气管插管对患者循环功能影响较小,并发症少,插管时间缩短。     

困难气道老年患者视频喉镜与直接喉镜下经口气管插管应激反应比较

目的比较用Glide Scope视频喉镜和Macintosh直接喉镜经口气管插管的老年困难气道患者应激反应发生情况。方法选择拟在全身麻醉下实施择期手术的老年困难气道患者40例,ASA分级Ⅰ～Ⅲ级、年龄65岁以上、Cormack-Lehane分级Ⅲ～Ⅳ级,随机分为Glide Scope视频喉镜组(G组)和Macintosh直接喉镜组(M组),各20例。麻醉诱导后分别使用Glide Scope视频喉镜和Macintosh直接喉镜显露声门行气管插管。记录各组患者的插管时间及基础值(T0)、诱导后插管前即刻(T1)、及插管后1 min(T2)、5 min(T3)、10 min(T4)、30 min(T5)的心率(HR)、收缩压(SBP)、舒张压(DBP)数值;并于T0、T3、T4、T5时检测血浆肾上腺素(E)、去甲肾上腺素(NE)、肾素、血管紧张素Ⅱ(ATⅡ)的浓度。结果与T0相比,T2、T3时两组及T4时M组HR、SBP、DBP均升高(P<0.05),T5时M组的SBP升高(P<0.05),T3、T4时两组血浆EN、E、肾素、ATⅡ浓度升高(P<0.05),T5时M组血浆肾素、ATⅡ浓度升高(P<0.05);与G组比较,M组T3、T4时HR、SBP、DBP及T5时SBP升高(P<0.05),T4时血浆EN、E、肾素浓度及T5时肾素、ATⅡ浓度升高(P<0.05)。G组插管时间明显短于M组(P<0.05)。结论与Macintosh直接喉镜相比,应用Glide Scope视频喉镜行经口气管插管可以减轻老年困难气道患者血流动力学变化,降低应激反应的程度。     

纤维支气管镜引导下柔性气管导管行气管插管的临床应用

目的探讨用纤维支气管镜（FOB）引导柔性气管导管（PFHV）行气管插管的临床效果。方法将90例行普外科手术患者均分为三组,Ⅰ组用7．0号普通气管导管,Ⅱ组用7．0号PFHV,Ⅲ组用7．5号PFHV。常规麻醉诱导后,在FOB引导下行经口气管插管,记录麻醉诱导前、插管前即刻,插管后即刻、1min、3min、5min的血压及心率,以及置入气管导管的情况（顺利、需旋转后置入或不能置入）。术后24h随访患者咽喉疼痛不适发生情况。结果Ⅰ组置管不顺利25例,失败1例;Ⅱ、Ⅲ组均顺利置入导管。与Ⅰ组比较,Ⅱ组在插管后即刻、3min的血流动力学波动幅度小,术后咽喉疼痛不适发生者少（P均〈0．05）。Ⅱ、Ⅲ组各指标比较无统计学差异。结论FOB引导PFHV行气管插管操作简单,成功率高,对患者损伤小。     

Three-day tracheal intubation manikin training for novice doctors using Macintosh laryngoscope,McGRATH MAC videolaryngoscope and Pentax AirwayScope

Background:We compared the intubation skills obtained by novice doctors following training using 3 instruments, the conventional Macintosh laryngoscope (Mac) and 2 types of indirect video-laryngoscopes (McGrath^TM-MAC: McGrath (McG) and AirwayScope (AWS)), to determine the most appropriate instrument for novice doctors to acquire intubation skills, especially focusing on visual confirmation of vocal cords, during a 3-day intensive manikin training program.Methods:Fifteen novice doctors who did not have sufficient experience in endotracheal intubation (ETI) and consented to participate in this study were included. We used AirSim and AMT (Airway management Trainer) manikins. First, an experienced anesthesiologist instructed the trainees on using the 3 instruments for a few minutes. Then, after familiarizing themselves with each device for 10 minutes, the participants attempted ETI on the 2 manikins with the 3 devices used in random order. Intubations with each device were practiced and performed for 3 successive days. We assessed the percentage of glottic opening (POGO) score, successful intubation rate and tracheal intubation time for each participant, with each device, and on each day.Results:In the first manikin, AirSim, POGO scores in the McG and AWS groups were significantly higher than those in the Mac group on all 3 days (P < .0001). The number of intubation failures in the Mac group decreased from 2 cases on day 1, to 1 case on day 2 and zero cases on day 3. There were no failures in the McG and AWS groups on any of the days. With the second manikin, AMT, POGO scores in the Mac group were significantly lower than those in the McG and AWS groups on all 3 days. There were no intubation failures in the AWS group on all 3 days. In the Mac group, the number of intubation failures decreased from 3 on day 1, to 2 on day 2 and zero failures on day 3. In the McG group, there were only 3 failures on day 1.Conclusion:The 2 types of indirect video-laryngoscopes (McGRATH and AirwayScope) were demonstrated to be suitable instruments for novice doctors to achieve higher POGO scores in a 3-day intensive ETI training.     

Use of the GlideScope does not lower the hemodynamic response to tracheal intubation more than the Macintosh laryngoscope: a systematic review and meta-analysis

Background:It is presently unclear whether the hemodynamic response to intubation is less marked with indirect laryngoscopy using the GlideScope (GlideScope) than with direct laryngoscopy using the Macintosh laryngoscope. Thus, the aim of this study was to determine whether using the GlideScope lowers the hemodynamic response to tracheal intubation more than using the Macintosh laryngoscope.Methods:We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim was to determine whether the heart rate (HR) and mean blood pressure (MBP) 60 s after tracheal intubation with the GlideScope were lower than after intubation with the Macintosh laryngoscope. We expressed pooled differences in HR and MBP between the devices as the weighted mean difference with 95% confidence interval and also performed trial sequential analysis (TSA). Second, we examined whether use of the GlideScope resulted in lower post-intubation hemodynamic responses at 120, 180, and 300 s compared with use of the Macintosh laryngoscope. For sensitivity analysis, we used a multivariate random effects model that accounted for within-study correlation of the longitudinal data.Results:The literature search identified 13 articles. HR and MBP at 60 seconds post-intubation was not significantly lower with the GlideScope than with the Macintosh (HR vs MBP: weighted mean difference = 0.22 vs 2.56; 95% confidence interval −3.43 to 3.88 vs −0.82 to 5.93; P = .90 vs 0.14; I² = 77% vs 63%: Cochran Q, 52.7 vs 27.2). Use of the GlideScope was not associated with a significantly lower HR or MBP at 120, 180, or 300 s post-intubation. TSA indicated that the total sample size was over the futility boundary for HR and MBP. Sensitivity analysis indicated no significant association between use of the GlideScope and a lower HR or MBP at any measurement point.Conclusions:Compared with the Macintosh laryngoscope, the GlideScope did not lower the hemodynamic response after tracheal intubation. Sensitivity analysis results supported this finding, and the results of TSA suggest that the total sample size exceeded the TSA monitoring boundary for HR and MBP.     

Comparison of tracheal intubation between sitting position and standing position in COVID-19 patients: A manikin study

It is recommended to use visual laryngoscope for tracheal intubation in a Corona Virus Disease 2019 patient to keep the operator farther from the patient. How the position of the operator affects the distance in this setting is not ascertained. This manikin study compares the distances between the operator and the model and the intubation conditions when the operator is in sitting position and standing position, respectively.Thirty one anesthesiologists with minimum 3-years’ work experiences participated in the study. The participant''s posture was photographed when he performed tracheal intubation using UE visual laryngoscope in standing and sitting position, respectively. The shortest distance between the model''s upper central incisor and operator''s face screen (UF), the horizontal distance between the model''s upper central incisor and the operator''s face screen, the angle between the UF line and the vertical line of the model''s upper central incisor were measured. The success rate of intubation, the duration of intubation procedure, the first-attempt success rate, the Cormack–Lehane grade, and operator comfort score were also recorded.When the operator performed the procedure in sitting position, the horizontal distance between the model''s upper central incisor and the operator''s face screen distance was significantly longer (9.5 [0.0–17.2] vs 24.3 [10.3–33.0], P ≤ .001) and the angle between the UF line and the vertical line of the model''s upper central incisor angle was significantly larger (45.2 [16.3–75.5] vs 17.7 [0.0–38.9], P ≤ .001). There was no significant difference in UF distance when the operator changed the position. Cormack–Lehane grade was significantly improved when it was assessed using visual laryngoscope. Cormack–Lehane grade was not significantly different when the operator assessed it in sitting and standing position, respectively. No significant differences were found in the success rate, duration for intubation, first-attempt success rate, and operator comfort score.The operator is kept farther from the patient when he performs intubation procedure in sitting position. Meanwhile, it does not make the procedure more difficult or uncomfortable for the operator, though all the participants prefer to standing position.     

老年患者股动脉和颈动脉及冠状动脉粥样硬化斑块稳定性的比较

目的　探讨股动脉、颈动脉、冠状动脉粥样硬化斑块的稳定性。方法　收集我院老年尸体解剖病例 15例 ,将所有病例的两侧股动脉、两侧颈动脉、左冠状动脉前降支进行连续取材 ,常规病理检查 ,部分节段行α 平滑肌肌动蛋白、CD6 8、bax染色。结果　股动脉粥样硬化斑块中的平滑肌细胞、巨噬细胞数量与颈动脉相近。与冠状动脉比较 ,股动脉粥样硬化斑块中的平滑肌细胞相对多 ,巨噬细胞相对少 ;bax在巨噬细胞的表达多 ,在平滑肌细胞的表达少。结论　平滑肌细胞、巨噬细胞数量的不同导致了 3种动脉粥样硬化斑块不同的稳定性。股动脉中的粥样硬化斑块较冠状动脉更稳定。     

Research and Clinical Applications of Optical Coherence Tomography in Invasive Cardiology: A Review

In cardiology, optical coherence tomography (OCT) is an invasive imaging technique based on the principle of light coherence. This system was developed to obtain three-dimensional high resolution images to examine coronary artery normal and/or pathological structure. This technique replaces the ultrasound used by its main alternative procedure, intravascular ultrasound, by a near-infrared light source. Acute coronary syndromes due to atherosclerotic vascular disease are the leading cause of mortality in developed and developing countries. As a consequence, intravascular imaging systems became an important area of research and 1991 marks the first use of OCT in coronary artery observations. Since its first appearance in invasive cardiology, OCT maintains a strong presence in the research environments for the identification of vulnerable plaques, as it is able to overcome difficulties presented by other techniques such as virtual intravascular ultrasound, near-infrared spectroscopy, and histology. Moreover, OCT is increasingly being used in the clinical practice as a guide during coronary interventions and in the assessment of vascular response after coronary stent implantation. This review focuses on the relevance of OCT in research and clinical applications in the field of invasive cardiology and discusses the future directions of the field.     

Evaluation of the correlation between preoperative airway assessment tests,anthropometric measurements,and endotracheal intubation difficulty in obesity class III patients undergoing bariatric surgery

In this study, we investigated the correlation between airway assessment tests, anthropometric measurements, and the Modified Cormack– Lehane Classification (MCLC) assessed by videolaryngoscopy in patients undergoing bariatric surgery.This study included 121 morbidly obese patients undergoing bariatric surgery. The body mass index, Modified Mallampati Score (MMS), thyromental distance, sternomental distance, interincisor distance, and neck, waist, and chest circumferences were recorded. The correlation between the airway assessment tests, anthropometric parameters, and the MCLC were analyzed. The time required for endotracheal intubation (EI) and the attempt required for EI were also recorded.Thirty-three patients were found to be at risk of a difficult EI. The MMS, neck circumference, waist circumference, chest circumference, the time required for EI, and the number of attempts for EI were positively correlated with MCLC (all P < .05). As the MMS increased, the risk of a difficult EI increased (P < .001). The cutoff values of neck, waist, and chest circumference for the risk of a difficult EI were 41.5, 153.5, and 147.5 cm, respectively (P < .05).This study indicates that the high MMS, as well as increased neck, waist, and chest circumference, should be considered EI difficulty in obese patients, even if a videolaryngoscopy is used.     

三尖瓣关闭不全直视成形术的临床研究

目的 探索理想的三尖瓣成形术方法。方法 自制了三尖瓣成形术的塞规。将40例中、重度继发性三尖瓣关闭不全的患者随机分为两组；术中测量每例患者三尖瓣环的长度；A组行改进的精确量化三尖瓣成形术；B组行精确量化De Vega成形术。观察手术前后血液反流及血流动力学变化。结果 风心病患者三尖瓣前、隔、后瓣环长度之比为：1．27：1：0．9；术后血液反流及血流动力学较术前明显改善，A组较B组改善更好，两组均未发生三尖瓣狭窄。结论 风心病患者三尖瓣环以前、后瓣环扩张为主，隔瓣环基本不扩张。塞规有良好的实用性；精确量化三尖瓣成形术治疗继发性三尖瓣关闭不全，能取得良好的疗效；改进的方法是值得推广的。