喉镜辅助光棒在困难气管插管中的临床应用

目的 探讨喉镜辅助下光棒在困难气管插管中的临床应用效果.方法 全麻插管手术患者120例,Yamamoto气道评级Ⅲ～Ⅳ级,随机均分为三组:喉镜组(A组)、单纯光棒组(B组)及喉镜辅助光棒组(C组).记录患者插管前后MAP、HR、去甲肾上腺素(NE)和肾上腺素(E)的变化,及插管成功率、插管时间、插管后并发症的发生情况.结果 与诱导后比较,插管即刻和插管后1min三组患者MAP、NE和E均显著升高,HR明显增快(P＜0.05),且A组高于B、C两组(P＜0.05),B、C两组相比差异无统计学意义.插管成功率A组为82.5％,B组为77.5％,C组为100％,C组显著高于A、B组(P＜0.01).插管时间A组为(43.3±12.5)s,B组为(47.1±15.1)s,C组为(31.1±10.7)s,C组显著短于A、B组(P＜0.05).结论 喉镜辅助下光棒在困难气管插管中成功率高、时间短,对血流动力学影响较轻,术后并发症少.     

自制麦克风光棒联合导管芯在困难气管插管中的应用

目的观察自制麦克风光棒联合导管芯在困难气管插管中的临床应用效果。方法42例已预料困难气道行气管插管全麻患者,按随机数字表法分为自制麦克风光棒联合导管芯气管插管组（Ⅰ组）和普通喉镜气管插管组（Ⅱ组）,每组21例。记录两组患者的一次插管成功率、插管时间,观察气管插管并发症如插管即刻的血流动力学改变、口咽黏膜出血以及术后6h的咽喉疼痛和声音嘶哑情况。结果与Ⅱ组比较,Ⅰ组的一次插管成功率（90．5％VS57．1％）明显增高（P〈0．05）,插管时间（86±19）s vs（276±36）s明显缩短（P〈0．05）;Ⅰ组的插管即刻血流动力学改变、口咽黏膜出血、术后6h咽喉痛和声音嘶哑明显少于Ⅱ组（P〈0．05）。结论自制麦克风光棒联合导管芯对困难气管插管是一种比较安全、有效的方法,有一定临床应用价值。     

光棒联合直接喉镜气管插管对心率变异性的影响

目的观察光棒联合直接喉镜气管插管对心率变异性（heart rate variability,HRV）的影响,评价光棒联合喉镜进行气管插管的临床应用安全性和可行性。方法拟行气管插管全身麻醉患者80例,采用随机数字表法分为直接喉镜组（A组）和光棒联合直接喉镜组（B组）,每组40例。应用功谱分析法记录诱导前（TO）、诱导后（T1）、插管即刻（T2）及插管后1min（T3）、5min（T4）的HRV的总频（total frequency,TF）、高频（high frequency,HF）、低频（low frequency,LF）和LF／HF比率（LF／HF ratio,LF／HF）,同时记录各时间点的心率（heart rate,HR）、收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）、各组插管时间、插管成功率及出现相关并发症例数。结果与T1时TF、LF[（795±167）、（265±87）ms^2／HZ]比较,A组患者T2、T3时的TF[（1825±207）、（1692±198）ms^2／HZ]、LF[（815±129）、（796±127）ms^2／HZ]和LF／HF（4．6±0．9;412±0．6）明显增加,A组增加程度大于B组（P〈0．05）;A组相应时间点HR、SBP及DBP增加程度也明显大于B组（P〈0．05）;B组插管成功率明显高于A组,而插管时间及并发症显著低于A组（P〈0．05）。结论光棒联合直接喉镜气管插管对HRV影响小、插管时间短、插管成功率高、并发症少,是一种安全有效的插管方法。     

经Airtraq喉镜使用钢丝加强型导管和普通气管导管的比较

目的 观察Airtraq喉镜使用钢丝加强型导管和普通气管导管进行气管插管的临床效果.方法 90例行择期整形外科手术的需气管插管的全麻患者,随机分为钢丝加强型导管组(A组)和普通导管组(B组),每组45例.常规静脉快速诱导后,用Airtraq喉镜分别携带钢丝加强型导管或普通气管导管行气管插管.观察两组患者的插管时间、插管成功率、插管期间的血流动力学变化以及术后并发症的发生情况.结果 所有患者全部用Airtraq喉镜完成气管插管,B组一次插管成功率(91.1%)低于A组(95.6%)(P＜0.05);B组插管时间[(35.4±16.6)s]显著长于A组[(26.8士9.0)s](P＜0.05),两组血流动力学变化及术后并发症的发生情况差异无统计学意义.结论 Airtraq喉镜能够安全有效地应用于全麻患者的气管插管,使用钢丝加强型导管可以进一步提高插管成功率,缩短插管时间.     

光棒和插管型喉罩在盲探气管插管中的比较

目的 比较光棒和插管型喉罩在盲探气管插管中的应用效果.方法 拟行气管内插管患者100例,ASA Ⅰ或Ⅱ级,随机均分为光棒组(A组)和插管型喉罩组(B组).记录诱导前、诱导后、插管即刻、插管后1、3、5 min的SBP、DBP、HR、SpO2变化及首次插管成功率和总成功率、插管时间、并发症等.结果 A、B组首次插管成功率分别为76%和80%,插管总成功率分别为96%和98,插管时间分别为(38.9±16.1)s和(76.1±18.0)s(P<0.05).结论 光棒和插管型喉罩在盲探气管插管中成功率高、并发症少,可安全用于盲探气管插管.     

光棒与纤维支气管镜用于强直性脊柱炎困难气道气管插管的比较

目的 比较光棒(light wand,LW)与纤维支气管镜(fiberoptic bronchoscope,FOB)用于强直性脊柱炎患者的困难气道行气管插管的应用效果.方法 选择62例行择期手术的强直性脊柱炎患者,随机分为LW引导气管插管组(LW组,n=32)和FOB引导气管插管组(FOB组,n=30),经口行气管插管,记录插管时间、成功率,评估血流动力学及插管相关并发症.结果 LW组患者气管插管时间明显短于FOB组(P＜0.01),在插管成功率、气管插管相关并发症及血流动力学变化等方面,两组之间差异无统计学意义(P＞0.05).结论 LW和FOB均可用于强直性脊柱炎患者困难气道的气管插管,成功率高,并发症少,对血流动力学影响轻微,而LW操作更为简单,并能缩短气管插管时间.     

光棒气管插管折弯方法的研究

目的探讨光棒气管插管时其前端折弯的最佳方法。方法72例患者随机均分为三组,A组:采用下颌骨颏角至舌骨的长度作为光棒折弯部分的长度;B组:以“门甲垂线距离”作为光棒折弯长度[测算方法,分别从上门齿和甲状软骨最高点(喉结)向侧面作两条与手术床垂直的线,两条垂线的水平距离即为光棒折弯长度];C组:“门甲垂线距离” 1cm作为光棒折弯长度。分别观察和记录插管时间、插管次数、插管成功率、血液动力学变化及不良反应。结果三组患者插管均成功,其中B组的插管时间和一次插管成功率与A、C两组相比差异有显著意义(P<0.05);三组患者的血液动力学差异无显著意义。结论以“门甲垂线距离”作为光棒气管插管时其前端折弯长度的标准,方法简便,容易定位、一次插管成功率高。     

不同弯曲度导管芯用于Tosight~视频喉镜气管插管的比较

目的比较Tosight视频喉镜气管插管时使用不同弯曲度导管芯的插管效果。方法 120例18~55岁ASAⅠ或Ⅱ级患者,无困难气道表征及病史,按导管芯的弯曲角度(弯折点在套囊上方的1cm内)随机均分为三组:A组(弯曲为40°)、B组(弯曲为60°)和C组(弯曲为80°)。快速诱导后采用Tosight视频喉镜经口气管插管,观察记录三组Tosight视频喉镜喉部显露分级、声门暴露时间、气管插管时间和插管次数和并发症的发生情况;记录插管期间的血流动力学变化。结果所有患者均成功完成气管插管操作,A、B和C组的一次插管成功率分别为37例(92.5%)、39例(97.5%)和40例(100.0%),A、B组分别有3例和1例在改变导管芯角度第2次完成气管插管。三组的声门暴露时间差异无统计学意义,C组插管总时间明显短于A组和B组(P0.05);三组插管期间无明显血流动力学改变,均无严重并发症。结论 Tosight视频喉镜用于成人气管插管时,三种导管芯的弯曲角度均能完成气管插管,其中80°的一次成功率最高,插管时间最短。     

Berman airway在经口纤维支气管镜气管插管中的临床应用

目的探讨应用Berman airway在经口纤维支气管镜引导气管插管中的安全性和有效性。方法ASAⅠ-Ⅱ级,年龄25—55岁择期行妇科腹腔镜手术的60例患者,随机分为两组行纤维支气管镜经口气管插管：A组辅用Berman airway（n=30）,B组未辅用Berman airway法（n=30）。麻醉前进行气道评估分级（Ⅱ-Ⅲ级）,并分别记录麻醉诱导前（T0）,麻醉诱导后（T1）,气管插管即刻（T2）及插管后1min（T3）、3min（T4）的收缩压（SBP）、心率（HR）以及声门暴露、送管、插管时间及相关并发症等。结果A组声门暴露、送管及插管时间均短于B组,差异具有统计学意义（P〈0．05）。血流动力学比较：组内比较,A组SBP、HR在各时间点均无统计学差异（P〉0．05）,B组T2时间点SBP、HR较T1时升高（P〈0．05）,与其它时间点比较无统计学差异（P〉0．05）。组间比较,B组他时SBP、HR均高于A组（P〈0．05）,其余各时点比较两组间均无统计学差异（P〉0．05）。A组术后咽痛2例（6．7％）,B组8例（26．7％）,组间比较差异有统计学意义（P〈0．05）。结论纤维支气管镜经口气管插管中应用Berman airway,可缩短插管时的声门暴露时间及插管时间,使送管更加顺利,并提供更加稳定的血流动力学。     

Proseal喉罩与支纤镜联合Aintree导管用于颈椎不稳患者气管插管的临床研究

目的 通过与清醒经鼻支纤镜插管对比,研究Proseal喉罩与支纤镜联合Aintree导管用于颈椎不稳患者气管插管的有效性和安全性。方法 因颈椎骨折或严重颈椎间盘突出拟行颈椎减压内固定手术的患者40例,随机分配至以下两组：A组20例,清醒表麻后行经鼻支纤镜引导插管,然后麻醉诱导;B组20例,常规麻醉诱导后置入Proseal喉罩,沿喉罩在支纤镜引导下将Aintree导管插入气管内,退出喉罩后经Aintree导管置入气管插管。监测插管前（T0）、开始插管（T1）、插管成功时（T2）、插管成功后1min（T3）、插管成功后3min（T4）的平均动脉压（MAP）和心率（HR）;记录支纤镜插管时间、插管总时间（表麻时间或置喉罩时间加支纤镜插管时间）和插管相关并发症。结果 A组有1例因不能配合改为诱导后支纤镜插管,B组所有病例插管成功。T2和T3两时点,A组HR（92±17次/分,95±18次/分）显著高于B组（78±13次/分,83±17次/分）;T3时点A组MAP（93±28mmHg）显著高于B组（80±24mmHg）（P<0.05）;A组在T2、T3两时点的HR、MAP均显著高于各自的T0时点基础值（P<0.05）。插管的总时间两组相当（A组184±55s,B组179±27s,P>0.1）,而B组支纤镜插管时间较短（A组62±32s,B组39±18s,P<0.05）。两组患者术后无任何插管相关并发症。结论 Proseal喉罩与支纤镜联合Aintree导管用于颈椎不稳患者气管插管与传统支纤镜清醒插管效果相当,但血流动力学更平稳,是安全有效的困难气道处理新技术。     

光棒辅助与普通喉镜气管插管用于颈椎骨折手术患者的比较

目的比较光棒辅助与普通喉镜气管插管用于颈椎骨折全麻患者的插管效果和安全性。方法选择拟行气管插管全麻的颈椎骨折手术患者40例,男28例,女12例,年龄18~65岁,ASAⅡ或Ⅲ级,随机分为两组,每组20例。全麻诱导后,L组采用光棒引导气管插管,C组采用普通喉镜辅助气管插管。记录一次插管成功例数、插管时间,插管前5 min、插管即刻和插管后5 min的MAP和HR,以及插管时不良反应情况。结果 L组的一次性插管成功率明显高于C组(90%vs.60%),插管时间明显短于C组[(31.3±11.1)s vs.(46.6±15.2)s](P0.05)。与C组比较,L组患者插管期间MAP和HR变化更平稳。C组有4例(20%)心律失常,L组无一例心律失常。结论与普通喉镜比较,光棒引导气管插管用于颈椎骨折手术患者插管更容易,安全性更好。     

A comparative study of tracheal intubation using an intubating laryngeal mask (Fastrach) alone or together with a lightwand (Trachlight)

Study Objective: To determine if the Trachlight^TM lightwand can facilitate Fastrach^TM intubation by guiding the tip of the endotracheal tube into the trachea.

Design: Open-label, prospective, randomized, comparative study.

Setting: General operating suites of a tertiary teaching hospital.

Patients: 172 elective surgical patients requiring general anesthesia with endotracheal intubation.

Interventions: With general anesthesia, the Fastrach™, which is a new intubating laryngeal mask airway, was inserted into the oropharynx. Ventilation was ensured before the insertion of an endotracheal tube via the Fastrach™. Tracheal intubation was then performed randomly (coin toss) using either the endotracheal tube alone (Fastrach™ group), or endotracheal tube with the Trachlight, a lightwand (Fastrach/Trachlight™ group). The time to place the Fastrach™ and endotracheal tube, to remove the Fastrach™, and the total time to intubate were recorded. The number of attempts, failures, trauma, sore throats, and hemodynamic changes were also recorded. Data were analyzed using unpaired t-test, ANOVA with repeated measures, or Chi-squares contingency table where appropriate.

Measurements and Main Results: Although there were no differences in the times to place the Fastrach™, and endotracheal tube, the hemodynamic changes, and postoperative complications, there were significantly more attempts and failures in the Fastrach™ group compared to the Fastrach™/Trachlight™ group. There were no differences in the incidence of sore throat and trauma in between the groups.

Conclusions: Although tracheal intubation is effective using a Fastrach™ alone (76% success rate), it is more effective when the Fastrach™ is used in conjunction with the Trachlight™ (95%). These results suggest that the lightwand is a useful adjunct for Fastrach™ intubation. However, the role of Fastrach™ intubation together with the Trachlight™ in the management of patients with a potential difficult airway remains to be determined.     

不同的氧气流量对雾化吸入利多卡因进行表面麻醉效果的影响

目的探讨不同的氧气流量对雾化吸入2%利多卡因进行气道表面麻醉效果的影响。方法选择需行清醒气管插管的困难气道患者75例,按随机数字表法分为A、B、C三组(n=25),所有患者都通过氧气驱动雾化吸入2%利多卡因10 m L的方法进行气道黏膜表面麻醉,但A、B、C三组患者所用的氧气流量分别为3 L/min、6 L/min、9 L/min,雾化吸入结束后使用纤支镜引导进行气管插管。评估记录插管条件和导管耐受性;记录气管插管首次成功率、总成功率、插管时间;记录不良心血管反应和并发症发生情况。结果与A组和C组比较,B组的插管条件、导管耐受性更好,气管插管首次成功率更高,插管时间更短(Ρ0.05);A、C两组间比较,无明显差异。结论在清醒气管插管过程中定量雾化吸入2%利多卡因进行气道粘膜表面麻醉时,氧气流量为6 L/min的效果更好。     

Intubation through intubating laryngeal mask with and without a lightwand: a randomized comparison.

The combined use of a lightwand and the intubating laryngeal mask airway (ILMA) was compared with the use of the ILMA alone to determine whether the combination was a more efficient method of endotracheal intubation. One hundred healthy patients were randomly assigned to two groups. After induction of anaesthesia, Group A patients were intubated blindly through the ILMA while in Group B, intubation was guided by a lightwand. A sequence of standard manoeuvres was followed it attempts at intubation failed. The number of manoeuvres used, the time taken for successful intubation and complications associated with intubation were recorded. Intubations were successful in all patients, but the mean endotracheal intubation time was longer in Group A than in Group B (38.3 +/- 10.4 s versus 26.4 +/- 9.1 s, P < 0.001). The number of patients who needed one or more manoeuvres was significantly higher in Group A than in Group B (76% versus 42%, P = 0.001). We conclude that the lightwand is a useful adjunct in endotracheal intubation through an ILMA.     

Airtraq喉镜和Macintosh直接喉镜在经口气管插管时血流动力学的比较

目的比较Airtraq视频喉镜和Macintosh直接喉镜经口气管插管时心血管反应。方法40例拟择期经口气管插管全麻下手术的患者,按照随机数字表随机分为两组,Airtraq组（A组）和Macintosh喉镜组（M组）,每组20例。观察麻醉诱导前、诱导后、插管即刻、插管后1、3min时的心率（HR）、血压和心率收缩压乘积（ratepressureproduct,RPP）。结果两组声门暴露时间差异无统计学意义（P〉0．05）,导管置入时间A组（6±4）S短于M组（10±4）S（P〈0．01）。两组诱导后的HR、血压和RPP值都较诱导前的基础值明显下降（P〈0．05）,插管即刻、插管后1min的心血管指标较诱导后明显增高（P〈0．05）。A组插管后3min心血管指标与诱导后比较差异无统计学意义（P〉0．05）,而M组3min时心血管指标[收缩压（SBP）（106±17）mmHg（1mmHg=0．133kPa）,舒张压（DBP）（65±10）mmHg,平均动脉压（MAP）（78±19）mmHg,HR（92±12）次／分,RPP（9748±2072）]与诱导后[SBP（93±15）mmHg,DBP（54±9）mmHg,MAP（67±10）mmHg,HR（85±12）次／分,RPP（8117±1886）]比较差异仍有统计学意义（R0．05）。A组、M组插管后5min心血管指标与诱导后比较差异均无统计学意义。结论与Macintosh直接喉镜相比,应用Airtraq视频喉镜行经口气管插管可减少插管置入时间,且血流动力学反应较轻。     

SLIPA喉罩在烧伤整形手术麻醉中的应用

目的：评估SLIPA喉罩在烧伤整形手术麻醉中的应用效果,并探讨其安全性和有效性。方法：ASAⅠ-Ⅱ级择期瘢痕切除植皮术患者80例,随机均分为SLIPA喉罩组（L组）和气管插管组（T组）,分别记录两组患者在麻醉诱导前、诱导后,插管（喉罩）时、手术开始后10mi n及术毕拔管（喉罩）时的心率（HR）,血氧饱和度（SPO2）,收缩压（SBP）,舒张压（DBP）的变化,记录人工气道建立成功时、成功后30im n及手术结束时的平均气道压（Pmean）、气道峰压（Ppeak）、呼气末二氧化碳分压（PetCO2）和术后咽喉疼痛的病例数。结果：两组均能顺利完成手术,喉罩组和气管插管组在人工气道建立成功时、成功后30im n及手术结束时Pmean、Ppeak、Pet CO2比较,差异均无统计学意义;L组的血流动力学变化明显少于T组,两组比较有显著性差异,术后咽喉痛痛的例数也少于T组。结论：全麻SLIPA喉罩通气用于烧伤整形手术患者优于气管插管,易于维持血流动力学稳定,应激反应轻微,全麻后恢复平稳。     

Optimal length and angle of a new lightwand device (Trachlight).

STUDY OBJECTIVE: To investigate the effects of angle and length of the Trachlight lightwand and the effect of obesity on transillumination of the neck and difficulty of intubation. DESIGN: Prospective, randomized study. SETTING: Operating room of a university hospital. PATIENTS: 270 patients, aged 30 to 70 years, requiring anesthesia. INTERVENTION: Three different studies were performed. 1) One hundred twenty adults for general anesthesia to test the effect of the angle, 2) 120 patients for the length of the extrusion, and 3) 30 patients with body weight > or = 120% of the standard (Broca's formula) versus 30 with body weight < 120% of the standard to test the effect of the obesity. 1) The lightwand was bent at 20 degrees, 40 degrees, 60 degrees, or 80 degrees with 0 cm extruded from the endotracheal tube; 2) the lightwand was exposed from the endotracheal tube with -0.5, 0, 1, 2, 3, or 4 cm with 40 degrees angle; and 3) the effect of obesity was tested with 40 degrees angle and 0-cm extrusion. Endotracheal intubation was performed using the lightwand. Transillumination of the light at neck and the difficulty of intubation were assessed. MEASUREMENTS AND MAIN RESULTS: 1) A 20 degrees angle decreased the transillumination and an 80 degrees angle increased the number of difficult intubation. 2) Transillumination decreased with -0.5 cm and 0 cm extrusion. Difficult intubation increased with the extrusion > or = 3 cm. 3) Transillumination decreased and difficult intubation increased in the patients with body weight > or = 120% of the standard. CONCLUSIONS: To increase the success rate of tracheal intubation using the lightwand, the lightwand should be bent in 40 degrees to 60 degrees, with the extrusion of 1 to 2 cm from the tracheal tube. For obese patients with body weight > or = 120% of the standard, the lightwand was not useful.     

A comparison of hemodynamic changes after endotracheal intubation by using the lightwand device and the laryngoscope in normotensive and hypertensive patients

We compared the effects of the lightwand technique on hemodynamic responses, time-to-intubation, number of attempts, and complications during tracheal intubation with those of direct-vision laryngoscopy in normotensive (LN and TN group; n = 20, respectively) and hypertensive (LH and TH group; n = 20, respectively) patients. Lightwand or laryngoscopic oral endotracheal intubation was performed after the induction of anesthesia with fentanyl and propofol and muscle relaxation with vecuronium. Systolic blood pressure, diastolic blood pressure, and heart rate were recorded, and the change from "before intubation" to "immediately after intubation" (DeltaP) in each variable was calculated. In normotensive patients, significantly larger DeltaP in systolic blood pressure was observed in the LN group than in the TN group (P < 0. 05). In hypertensive patients, there were no significant differences between the LH group and the TH group in DeltaP after intubation. The time-to-intubation and number of attempts in the lightwand groups were significantly longer and more frequent than those in the laryngoscope groups (P < 0.05). The number of patients who complained of hoarseness was larger in the lightwand groups than in the laryngoscope groups (P < 0.05). We conclude that the lightwand technique significantly attenuates hemodynamic changes after intubation in comparison with the laryngoscopic technique in normotensive patients. However, in hypertensive patients, there is no difference in hemodynamic changes between the two techniques.