Glidescope 视频喉镜经鼻与经口气管插管的比较

目的:比较正常气道患者Glidescope视频喉镜引导下经鼻与经口气管插管操作时长的差异和对血流动力学及麻醉深度的影响.方法:择期在气管内全麻下行外科手术患者40例,依据数字表法随机分成经鼻组(n ＝ 20)和经口组(n ＝ 20).常规麻醉诱导后,采用Glidescope视频喉镜引导下实施经鼻与经口气管插管,记录气管插管时间、麻醉诱导前(基础值)、气管插管前、气管插管即刻及插管后1、2、3、4、5 min血压(BP)、心率(HR)及脑电双频谱指数(BIS).结果:两组患者一般情况比较差异无统计学意义;两组患者气管插管时间差异无统计学意义.与基础值相比,两组患者气管插管前BP、BIS降低(P ＜ 0.05),HR差异无统计学意义,气管插管即刻BP、HR差异无统计学意义,与气管插管前相比,两组气管插管即刻BP、HR和BIS均升高(P ＜ 0.05);与经鼻组相比,经口组插管后1 min HR增快(P ＜ 0.05), 两组各观察时点BP、BIS差异无统计学意义.结论:利用Glidescope视频喉镜引导下经鼻气管插管所需时间与经口气管插管所需时间差异无统计学意义,并且对血流动力学的影响更轻.     

视频喉镜用于下颌骨骨折患者经鼻气管插管的观察

目的 比较下颌骨骨折患者应用Glidescope视频喉镜(GSVL)和直接喉镜经鼻气管插管的效果.方法 选择下颌骨骨折手术患者38例,随机平均分为GSVL(A组)和直接喉镜(B组).观察声门暴露程度,插管时间,次数,麻醉诱导前、诱导后2分钟,气管插管时及插管后1、3、5分钟SBP、DBP、HR的变化.结果 A组声门显露程度分级降低,插管时间缩短,两组间各观察时点SBP、DBP、HR值差异无显著性.结论 GSVL用于下颌骨骨折患者经鼻气管插管能改善声门显露分级,缩短插管时间.     

光棒与直接喉镜经口气管插管心血管反应的比较

目的比较Lightwand光棒(LW)与Macintosh直接喉镜(MAC)经口气管插管对心血管反应的影响。方法将择期妇科手术患者40例随机分为LW组和MAC组,每组各20例,麻醉诱导后分别用LW或MAC实施经口气管插管。监测麻醉诱导前后、颈前光点或显露声门、气管插管即刻和气管插管后5 min内桡动脉有创收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和心率(HR)的变化;记录气管插管时间以及插管后血压(BP)及HR最大值出现时间。结果 MAC组气管插管时间明显长于LW组(P<0.05)。麻醉诱导后两组SBP、DBP和MAP均比麻醉诱导前显著降低(P<0.05);颈前光点或显露声门BP和HR较麻醉诱导后无明显变化(P>0.05);气管插管后血压比麻醉诱导后显著升高(P<0.05),持续约1~2 min后逐渐下降至麻醉诱导后水平;观察期间两组血压升高均未超过麻醉诱导前水平(P>0.05)。气管插管后两组HR比麻醉诱导前、后均显著升高(P<0.05),持续约3 min。两组间BP和HR在各对应时间点差异均无显著性(P>0.05)。结论采用LW与MAC实施经口气管插管可产生类似的心血管反应。     

经口或经鼻纤支镜引导插管对心血管的影响

目的：观察经口或经鼻纤支镜引导插管对心血管的影响。方法：16例择期手术病人,均系插管困难,随机分为经口组和经鼻组,在神经安定镇痛麻醉（NLA）加表麻下进行插管,监测插管前后血氧饱和度,血压及心率的变化。结果：与插管前相比,插管后SPO2显降低（P＜0．01）,HR,SBP,DBP,MAP,RPP均显增高（P＜0．05或P＜0．01）,插管后经鼻组与经口组相比,HR,SBP,MAP,RPP上升更显（P＜0．01）,SPO2和DBP变化不显（P＞0．05）,结论：NLA加表麻下纤支镜插管心血管反应较大,其中经鼻途径更甚于经口途径。     

气管插管型喉罩通气道与直接喉镜经口气管插管对血流动力学影响的比较

目的 气管插管型喉罩通气道（ILMA）为气管插管提供了一种新型途径，而且有望减轻气管插管时的心血管应激反应。但是，现有的研究结果并不一致。本研究目的在于：（1）进一步观察气管插管型喉罩通气道（ILMA）经口气管插管对血流动力学的影响；（2）证实经口气管插管时，气管插管型喉罩通气道（ILMA）是否能够比直接喉镜（DLS）产生较轻微的血流动力学反应。方法 择期整形外科手术患者53例，随机分为ILMA组和DLS组，经常规静脉诱导后气管插管。监测麻醉诱导前（基础值）、后，气管插管时和气管插管后5min内的血压（BP、收缩压SBP、舒张压DBP）和心率（HR）的变化。结果 ILMA组的平均气管插管操作时间较DLS组明显延长。气管插管后两组患者血压和心率均比麻醉诱导后明显升高，但血压的最大值未超过麻醉诱导前水平，而心率的最大值较麻醉诱导前明显升高。两组在各对应时问点的血压和心率无明显差异，血压和心率的最大值亦无明显差异。结论 在临床常用的全身麻醉深度下，ILMA和DLS经口气管插管操作引起的血流动力学反应相似。与DES相比较，ILMA引导经口气管插管并不具有减轻心血管反应的优点。     

视可尼喉镜改善老年高血压患者气管插管心血管应激反应

目的 比较应用视可尼喉镜与macintosh喉镜治疗老年高血压患者气管插管的心血管效果.方法 选择40例60～70岁全身麻醉下行腹腔镜手术患者,随机均分为视可尼喉镜组(A组)和macincosh喉镜组(B组).诱导前静脉注射艾司洛尔1.0 mg/kg,静脉诱导后分别采用视可尼喉镜或macintosh喉镜经口气管插管,观察麻醉诱导前后、气管插管时和插管后5 min内的血压、心率和心率与血压乘积(RPP)的变化.结果 A组插管时至插管后5 min内血压、心率和RPP均较诱导前显著降低(P＜0.05或P＜0.01).B组插管时至插管后3 min内血压和RPP则均增高(P＜0.05).心率轻度增高(P＞0.05).两组插管时和插管后1、3 min血压和RPP差异有显著性(P＜0.05).结论 采用视可尼喉镜经口气管插管,可明显减轻老年高血压患者的应激反应,且不会引起插管后血压下降和心肌收缩力降低,对高血压等潜在性心肌缺血患者尤为有利.     

纤维支气管镜和直接喉镜经口插管心血管反应的比较

目的:比较全身麻醉诱导后纤维支气管镜(FOB)和Macintosh直接喉镜(MAC)经口气管插管对心血管反应的影响.方法:30例择期神经外科手术患者分为FOB组(n=15)和MAC组(n=15),丙泊酚2 mg/kg、罗库溴铵0.6 mg/kg和舒芬太尼0.4μg/kg麻醉诱导后分别采用FOB和MAC实施经口气管插管,记录两组患者在显露声门、插管完成即刻和插管后1、2、3、4、5 min时收缩压(SBP)和心率(HR)的变化以及插管后最高SBP和HR出现时间.结果:FOB组插管时间明显长于MAC组[(26±3)svs(14±2)s,P=0.000];两组诱导即刻SBP均显著降低(P＜0.01),插管后1和2min时明显升高(P＜0.01),组间差异无显著性(P=0.501);两组诱导后即刻HR均无明显变化,插管后1和2 min时明显升高(P＜0.05),组间差异无显著性(P=0.636);插管后SBP和HR的最大升高值组间差异无显著性,FOB组HR最高值出现时间较MAC组明显提前[(34±14)s vs(47±20)s,P=0.04].结论:采用FOB和MAC经口气管插管引起的心血管反应无明显差别.     

经鼻与经口气管插管机械通气抢救呼吸衰竭的比较

目的：探讨经鼻和经口气管插管的临床应用价值。方法：采用一次性附有低压高容气囊的气管插管，对１０７例急性呼吸衰竭患者进行经纤维支气管镜引导下插管，经鼻与经口明视插管或盲插管，并进行两种插管方法的比较。结果：经鼻插管６２例次，经口插管５４例次（共１１６例次）；留管时间：经鼻插管平均１１．８天，经口插管平均６．６天，两组比较Ｐ＜０．００５；气管切开率：经鼻插管组为１２．９％，显著低于经口插管组４２．６％（Ｐ＜０．００１）；而拔管率经鼻插管组为５９．７％，则明显高于经口插管组４０．７％（Ｐ＜０．００５）。结论：经鼻气管插管机械通气优于经口插管气管插管机械通气，前者具有患者耐受性好、留管时间较长、并发症少等优点，可避免或减少气管切开。     

McCoy喉镜协助光纤插管镜经口困难插管

目的:观察McCoy喉镜协助光导纤维支气管镜(FOB)经口气管插管在全身麻醉诱导后困难气管插管中应用的临床效果。方法:将40例ASAⅠ或Ⅱ级全身麻醉诱导后McCoy喉镜窥喉不能看见声门任何部分的患者随机均分为两组(n=20):McCoy喉镜协助FOB经鼻插管组(对照组)和McCoy喉镜协助FOB经口插管组(研究组)。观察并记录两组麻醉诱导前(T0,基础值)、首次插管前(T1)、插管成功即刻(T2)和插管成功后1min(T3)的收缩压(SBP)、舒张压(DBP)和心率(HR)。统计两种方法插管一次成功率、多次成功率、插管耗时和插管并发症。结果:T0、T1、T2、T3等时点两组间SBP、DBP和HR经比较差异无统计学意义(P>0.05);气管插管一次成功率、插管耗时和插管并发症两组间经比较差异均无统计学意义(P>0.05),多次成功率均为100%。结论:McCoy喉镜协助FOB经口气管插管成功率高,耗时短,可作为全麻诱导后困难插管方法之一。     

ICU患者经口气管插管与经鼻气管插管后行气管切开的比较

目的探讨经口气管插管与经鼻气管插管在ICU留置时间,比较两组气管插管后行气管切开的比例。方法将42例气管插管患者随机分为经口气管插管组24例和纤维支气管镜引导下经鼻气管插管组18例,比较两组患者插管留置时间及插管后再行气管切开率。结果经鼻气管插管留置时间明显长于经口气管插管,经鼻气管插管后行气管切开的比例明显低于经口气管插管。结论纤维支气管镜引导经鼻气管插管在ICU是有效的,插管留置时间更长,部分经鼻气管插管患者避免行气管切开。     

Comparison of cardiovascular responses between orotracheal and nasotracheal intubation with the aid of GlideScope(R) videolaryngoscope

OBJECTIVE: To compare the cardiovascular responses to orotracheal or nasotracheal intubation with the aid of GlideScope(R) videolaryngoscope (GSVL). METHODS: Sixty patients, American Society of Anesthesiologists (ASA) physical statusI, aged 16-50 years, scheduled for elective plastic surgery under general anesthesia,were randomly allocated equally to the orotracheal intubation group (OTI group) and the nasotracheal intubation group (NTI group). After the routine anesthesia induction, orotracheal and nasotracheal intubation was respectively performed with the aid of GSVL. Non-invasive blood pressure and heart rate (HR) were recorded before (baseline values) and after anesthesia induction (postinduction values), during intubation and every minute for 5 minutes after intubation. Maximum values of blood pressure and HR during the observation periods were recorded. The product of HR and systolic blood pressure [rate pressure product (RPP)] at every time point was calculated. Duration for glottis exposure and duration for successful intubation were also noted. RESULTS: There were no significant differences between two groups in the demographic data (P>0.05). Glottis exposure time and intubation time in NTI group were significantly longer than those in OTI group [(52.2+/-13.5) seconds vs. (40.5+/-15.2) seconds, P<0.05]. After anesthesia induction,blood pressure and RPP in both groups decreased significantly compared with baseline values, but no significant change in HR was noted. Compared with their postinduction values, the blood pressure and RPP in both groups and HR in OTI group increased significantly at intubation. In OTI group,the maximum values of HR, diastolic blood pressure (DBP), mean arterial pressure (MAP), RPP exceeded their baseline values. But in NTI group,only maximal HR during the observation period was significantly higher than the baseline values. The blood pressure at every time point was not significantly different between two groups. But intubation in OTI group caused significant increases in HR and RPP compared with those in NTI group (both P<0.05). CONCLUSION:In anesthetiazed adult patients, orotracheal and nasotracheal intubations with the GSVL can result in a similar pressor response, however orotracheal intubation with GSVL causes more marked cardiovascular responses than nasotracheal intubation with the aid of GSVL.     

不同剂量艾司洛尔预防双腔支气管内插管时心血管反应的临床研究

目的观察不同剂量的艾司洛尔对预防双腔支气管内插管时心血管反应的临床效果及合适剂量。方法选择ASAⅠ～Ⅱ级开胸手术患者60例,随机分为三组,每组20人。A组：注射生理盐水10ml（对照组）,B组：静脉注射艾司洛尔0．5mg／kg,C组：静脉注射艾司洛尔1mg／kg,记录麻醉诱导前（基础值）、诱导后2min、插管后即刻、插管后2min、5min、10min的收缩压（SBP）、舒张压（DBP）、心率（HR）,计算各对应时点HR和收缩压（SBP）的乘积（RPP）。结果与基础值相比,诱导后2min三组SBP、DBP、HR和RPP均较基础值显著降低（P〈0．05）,B组降低的程度比A组更甚,但不及c组低;气管插管后即刻,A组、B组的SBP、DBP、HR和RPP显著升高（P〈0．05）,但B组增高的程度明显低于A组（P〈0．05）,而C组保持稳定;插管后2min、5min、10min三组SBP、DBP、HR和RPP随时间逐渐趋于基础值,但B、C组仍低于A组（P〈0．05）。结论应用0．5mg／kg和1mg／kg两种剂量的艾司洛尔均能有效抑制双腔支气管内插管引起的心血管反应,但1mg／kg艾司洛尔为合适剂量,且血流动力学稳定。     

星状神经节阻滞与全麻插管期心血管反应

目的 观察右星状神经节阻滞(R-SGB)对全身麻醉气管内插管期心血管反应的影响.方法 2009年10-12月选取60例美国麻醉医师协会(ASA)Ⅰ、Ⅱ级择期全麻手术患者,随机分为3组.研究组于全麻诱导前15 min用1%利多卡因10 mL经颈6入路行R-SGB,对照组1诱导前同法注射10 mL生理盐水,对照组2诱导前肌...     

视可尼喉镜不同入路方法气管插管对患者应激反应的影响

目的比较Shikani喉镜左侧磨牙入路、正中入路和Macintosh直接喉镜辅助下气管插管对患者应激反应的影响。方法选择60例ASAⅠ-Ⅱ级、年龄20—75岁,拟经口气管插管全身麻醉下行择期手术的患者,随机分为Shikani喉镜左侧磨牙入路组（A组,20例）、Shikani喉镜正中入路（B组,20例）和Macintosh直接喉镜辅助下Shikani气管插管组（C组,20例）。观察三组患者麻醉诱导前（T0）、麻醉诱导后（T1）、气管插管时（T2）和气管插管完成后1min（T3）、3min（T4）、5min（T5）内的血压（BP）、心率（HR）和心率变异性（HRV）的变化,并计算收缩压心率乘积（RPP）,同时记录气管插管完成所需时间,有无并发症。结果与T0相比,三组收缩压（SBP）、平均动脉压（MAP）、舒张压（DBP）、HR及RPP在不同时点均显著降低（P〈0．05或P〈0．01）;与A组相比,B组和C组的SBP、MAP、DBP在T2时显著增加（P〈0．05）,B组的HR、RPP在L—B时显著增加（P〈0．05）。与T0相比,B组的LF、LF/HF在不同时点显著增加（P〈0．05或P〈0．01）,A组HF显著增加,但LF／HF显著下降（P〈0．05）;与A组相比,B组的LF、LF／HF在L—L时增加显著（P〈0．05或P〈0．01）。三组患者插管均无明显并发症的发生。结论使用SOS硬光纤喉镜行经口气管插管时,左侧磨牙入路的方式对患者的应激反应最小;但对体质量较大颈部粗短的患者宜使用直接喉镜辅助的方式。     

Comparison of the effects of remifentanil andalfentanil on cardiovascular response to nasotracheal intubation: A prospective, randomized, double-blind study

Background:

Nasotracheal intubation is often necessary in patients undergoingelective or emergency maxillofacial surgery. Previous studies have suggested that the increase in blood pressure after nasotracheal intubation is significantly greater than the increase after orotracheal intubation. Many drugs, including narcotic analgesics, are effective in modifying cardiovascular responses to orotracheal intubation.

Objective:

The effects of remifentanil and alfentanil on the cardiovascularresponses to nasotracheal intubation were compared in healthy patients scheduled to undergo surgery.

Methods:

This prospective, randomized, double-blind study was conductedat the Department of Anesthesiology and Reanimation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey. Patients aged 16 to 65 years scheduled to undergo elective maxillofacial surgery and who were American Society of Anesthesiologists status I or 11 were randomly assigned to receive remifentanil 1 μg/kg in 10 mL saline over 30 seconds followed by an infusion of 0.5 μg/kg · min, or alfentanil 10 μg/kg in 10 mL saline over 30 seconds followed by an infusion of saline. Anesthesia was then induced with propofol, cisatracurium, and 1% isoflurane with 66% nitrous oxide in oxygen. Heart rate (HR) and systolic and diastolic arterial pressures (SAP and DAP, respectively) were measured noninvasively at 2 minutes before general anesthesia induction (baseline); 2 minutes after induction; and 1, 3, and 5 minutes after nasotracheal intubation. Patients were monitored for cardiac changes using electrocardiography.

Results:

Forty consecutive patients were enrolled in the study. Twenty patients (11 males, 9 females; mean [SD] age, 27.7 [12.6] years) received remifentanil, and 20 patients (12 males, 8 females; mean [SD] age, 31.5 [17.2] years) received alfentanil. Two minutes after anesthesia induction, mean (SD) arterial pressures decreased significantly from baseline in the remifentanil group (changes, 22 [8]/11 [6] mm Hg) and the alfentanil group (changes, 10 [9]/12 [8] mm Hg) (both, P < 0.05). Changes in SAP and DAP followed a similar pattern in both groups, but SAP was significantly lower in the remifentanil group compared with that in the alfentanil group throughout the study period (all, P < 0.05). After 1 minute of intubation, DAP was significantly lower in the remifentanil group compared with that in the alfentanil group (66 [9] mm Hg vs. 73 [20] mm Hg; P < 0.05). Compared with baseline, HR was decreased significantly in both groups throughout the study (all, P < 0.05). Except SAP in the alfentanil group, SAP, DAP, and HR were increased 1 minute after intubation compared with preintubation values. However, SAP, DAP, and HR remained significantly lower compared with baseline values throughout the study period in both groups (all, P < 0.05) except DAP at 1 minute after incubation in the alfentanil group. Five patients in the remifentanil group and 2 patients in the alfentanil group required treatment of hypotension. None of the patients in either group required treatment of bradycardia.

Conclusions:

In this study in healthy surgical patients aged 16 to 65 years, remifentanil 1 μg/kg given over 30 seconds, followed by a remifentanil infusion of 0.5 μg/kg · min, was similarly effective compared with alfentanil 10 μg/kg in attenuating the pressor response to nasotracheal intubation, but the incidence of hypotension in patients administered remifentanil was high.     

不同喉镜气管插管时的血流动力学比较

目的比较靶控诱导后Shikani喉镜、Macintosh直接喉镜和GlideScope视频喉镜插管时的应激反应。方法选取2008年12月-2009年2月期间ASAⅠ～Ⅱ级、拟于全身麻醉下行择期颅内占位病变切除术的患者30例,随机分为Shikani喉镜组（S组）、Macintosh直接喉镜组（M组）与GlideScope视频喉镜组（G组）。靶控异丙酚和瑞芬太尼诱导,分别采用上述3种喉镜行经口气管插管。记录患者的心率、血压,计算心率收缩压乘积（RPP）。结果 3组插管时间、心率、血压和RPP比较差异无统计学意义（P〉0.05）。S组和M组插管后心率、血压及RPP均较插管前显著升高（P〈0.05）,而G组插管后的心率、60～300s时的收缩压、平均动脉压和RPP与插管前比较,差异无统计学意义（P〉0.05）。结论 3种喉镜进行经口气管插管时具有相似的血流动力学反应,GlideScope视频喉镜更有利于循环稳定。     

视频喉镜、直接喉镜和纤维支气管镜经鼻气管插管的临床应用比较

目的：比较视频喉镜（GSVL）、直接喉镜（DLS）、纤维支气管镜（FOB）经鼻气管插管的临床应用效果,以便根据患者术前气道评估情况选择最正确的插管方法。方法：150例在经鼻气管插管全麻下行声带息肉摘除术的ASAⅠ~Ⅱ级患者随机分为3组：视频喉镜组（G组,n=50）,直接喉镜组（D组,n=50）,纤维支气管组（F组,n=50）。麻醉前进行气道评估分级（Ⅰ~Ⅳ）,并分别记录麻醉诱导前,麻醉诱导后,气管插管即刻,插管后1min、3min、5min的收缩压（SBP）、舒张压（DBP）、心率（HR）、收缩压与心率的乘积（RPP）以及气管插管成功率、插管时间等。结果：插管即刻、插管后1min的SBP、DBP、HR、RPP等指标升高F组〉D组〉G组,3组相比有显著差异（P〈0.05）。气管插管总成功率分别为98%（F组）、88%（G组）、76%（D组）,3组比较有显著差异（P〈0.05）。气道分级Ⅲ~Ⅳ级的患者插管成功率F组（91.7%）明显高于G组（40%）和D组（0%）（P〈0.05）。插管时间F组（59.3±13.6s）明显长于G组（37.8±9.3s）和D组（36.5±8.8s）（P〈0.05）。结论：视频喉镜经鼻气管插管的血流动力学反应最小,纤维支气管镜法的血流动力学反应大,气管插管成功率最高但耗费时间最长,适合于气道评估分析为Ⅲ~Ⅳ级气道的患者。直接喉镜法气管插管成功率最低,不适合困难气道患者。