视可尼喉镜经口不同径路气管插管对血流动力学影响的临床研究

目的 研究视可尼（Shikani Optical Stylet,SOS）左侧磨牙入路、正中入路和右侧磨牙入路经口气管插管对血流动力学的影响.方法 选择92例美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级、年龄20岁～65岁,拟在经口气管插管全身麻醉下实施择期手术的患者,采用随机数字表法分为3组：左侧磨牙入路组（SL组,30例）、正中入路组（SM组,32例）和右侧磨牙入路组（SR组,30例）.麻醉诱导后分别采用不同径路实施SOS经口气管插管操作,观察3组患者麻醉诱导前后、气管插管时和气管插管后5 min内的血压（blood pressure,BP）、心率（heart rate,HR）和二重指数（rate pressure product,RPP）的变化,并记录气管插管时间.结果 右侧磨牙入路经口气管插管的操作时间[（31±10）s]较左侧磨牙入路[（22±11）s]明显延长（P＜0.05）.麻醉诱导后,3组患者的BP[SL组：（94±15） mmHg/（59±10） mmHg（1 mmHg=0.133 kPa）;SM组：（95±17） mmHg/（56±9） mmHg;SR组：（102±14） mmHg/（58±9） mmHg]和RPP[SL组：7 125±1 826;SM组：7 127±1 826;SR组：7 326±1 621]均较麻醉诱导前[SL组：（132±11） mmHg/（72±9） mmHg;SM组：（135±11） mmHg/（72±6） mmHg;SR组：（136±14） mmHg/（71±1） mmHg;RPP：SL组：10 718±3 256;SM组：10 717±2 256;SR组：10 728±1 738]明显降低（P＜0.05）.与麻醉诱导后[SL组：（194±15）mmHg/（159±10）mmHg,HR：（77±16）次/min;SM组：（95±17） mmHg/（56±9）mmHg,HR：（77±16）次/min;SR组：（102±14）mmHg/（58±9） mmHg,HR：（74±13）次/min; RPP：SL组：7 125±1 826;SM组：7 127±1 826;SR组：7 326±1 621]比较,气管插管后3组患者的BP[SL组：（110±19） mmHg/（68±16） mmHg;SM组：（107±18） mmHg/（69±13） mmHg;SR组：（125±16） mmHg/（75±10） mmHg]、HR[SL组：（93±13）次/min;SM组：（93±17）次/min;SR组：（87±13）次/min]和RPP（SL组：9 234±2 787;SM组：9 234±2 689;SR组：9772±1 885）明显升高（     

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。     

Airtraq(R)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(R)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(R)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、3 min时的心率(HR)、血压和...     

视频喉镜与光导纤维支气管镜经鼻气管插管血流动力学反应的比较

本研究采用随机对照方法,在全身麻醉下对比观察了视频喉镜（GSVL）和光导纤维支气管镜（fiberoptic bronchoscope,FOB）经鼻气管插管时的血流动力学变化,旨在为经鼻气管插管时安全应用GSVL这一新型气管插管系统提供资料。     

GlideScope视频喉镜和Macintosh直接喉镜经鼻气管插管对血液动力学的影响

本研究皆在比较GlideScope视频喉镜和Macintosh直接喉镜经鼻气管插管时全麻患者的血液动力学变化,从血液动力学角度来观察GlideScope视频喉镜在经鼻气管插管中是否优于常用的Macintosh直接喉镜,为临床安全应用这一新型气管插管系统提供资料。     

Shikani喉镜左侧磨牙入路和直接喉镜经口气管插管对血流动力学的影响

目的 比较Shikani喉镜(SOS)左侧磨牙入路和Macintosh直接喉镜经口气管插管对血流动力学的影响.方法 40例全麻下择期手术患者,随机均分为SOS左侧磨牙入路气管插管组(S组)和Macintosh直接喉镜插管组(M组).观察两组患者麻醉诱导前(T0)、诱导后(T1)、气管插管即刻(T2)和气管插管后1 min(T3)、3 min(T4)、5 min(T5)的BP、HR,并计算SBP×HR(RPP),记录气管插管时间.结果 与T0时比较,T1时两组患者的BP和RPP均明显降低(P<0.05);与T1时比较,T2、T3耐两组患者的BP和RPP升高,T2～T5时两组患者HR明显增快(P<0.05).T2时S组SBP明显低于M组(P<0.05).与S组比较,M组气管插管开始后HR出现最大值的时间明显后延.观察期S组和M组SBP大于基础值30%的发生率和RPP大于22 000的发生率差异无统计学意义.两组患者的气管插管时间差异无统计学意义.结论 SOS左侧磨牙入路可简便有效地用于经口气管插管操作;与Macintosh直接喉镜比较,SOS左侧磨牙入路可引起较轻的血流动力学反应.     

GlideScope视频喉镜、直接喉镜和光导纤维支气管镜经口气管插管时血液动力学反应的比较

目的比较正常气道患者GlideScope视频喉镜(GSVL)、Macintosh直接喉镜(MDLS)和光导纤维支气管镜(FOB)经口气管插管时的血液动力学反应。方法拟在经口气管插管全身麻醉下行择期整形外科手术的患者60例,ASAⅠ或Ⅱ级,年龄18-50岁,随机分为3组(n=20):GSVL组、MDLS组和FOB组。常规麻醉诱导后,分别采用GSVL、MDLS或FOB实施经口气管插管,记录麻醉诱导前(基础值)、气管插管前即刻、气管插管后即刻及插管后1、2、3、4、5min血压(BP)和心率(HR),并记录整个观察期BP和HR的最大值。计算各观察时点的收缩压×心率乘积(RPP)。以时间为横坐标、观察期BP和HR为纵坐标计算血液动力学时-效关系曲线下面积。结果与MDLS组相比,FOB组气管插管时间延长(P<0.05),气管插管后即刻HR和RPP升高(P<0.05),GSVL组各指标差异无统计学意义;与GSVL组相比,FOB组各指标差异无统计学意义;3组血液动力学时-效关系曲线下面积差异均无统计学意义。结论与MDLS和FOB相比,采用GSVL在预防正常气道患者经口气管插管时血液动力学反应方面并无明显优势,但FOB引导经口气管插管时所致的血液动力学反应却强于MDLS。     

视频喉镜在气管插管术中的临床应用

目的 观察视频喉镜在气管插管术中的临床应用效果.方法 120例成年患者随机均分为三组:A组,用视频喉镜加普通喉镜插管;B组,用视频喉镜插管;C组,用普通喉镜插管.常规诱导,由熟练麻醉医师操作,观察可视声门程度、插管所用时间、插管次数、HR、MAP、SpO2的变化及失败例次.结果 可视声门程度、插管所用时间A组与B、C组比差异有统计学意义(P＜0.01).插管次数各组间差异有统计学意义(P＜0.01).HR、MAP、SpO2三组间及每组插管时、插管后与诱导前比较差异无统计学意义.结论 用视频喉镜加普通喉镜插管,比单用视频喉镜或单用普通喉镜插管,能提高声门可视程度,缩短插管所用时间,减少插管次数,降低插管失败比例.     

视频喉镜引导困难气管插管的护理配合

对69例气管插管困难患者在视频喉镜引导下气管插管成功,无一例因护理配合不当出现并发症。提出术前做好用物准备,对患者气管插管困难进行预测及判断患者有无寰椎关节运动受限或张口异常,针对性做好应对措施;术中熟练操作步骤,密切配合,加强生命体征观察,可提高气管插管成功率、减少损伤、增加安全性。     

喉镜及气管导管弯曲度对模拟颈椎制动患者气管插管的影响

目的 比较视频喉镜(GlideScope)和传统喉镜(Macintosh)及气管导管前端角度对模拟颈椎制动患者气管插管成功率和血流动力学的影响.方法 选择ASA Ⅰ或Ⅱ级无颈椎活动异常或困难气道拟择期手术的成人患者80例,无长期服用影响BP、HR药物史.麻醉诱导前配戴颈托模拟颈椎制动.麻醉诱导后,随机均分为四组:G1组(弯曲60°)、G2组(弯曲90°)、M1组(弯曲60°)及M2组(弯曲90°),行气管插管.观察喉镜暴露(C/L)分级、插管难易程度[采用视觉模拟评分(VAS)]、插管时间、插管次数,记录基础值、麻醉诱导中、气管插管即刻、插管后1、3、5 min时BP、HR变化.结果 G1、G2组C/L分级优于M1、M2组(P<0.05),G1、G2组VAS低于M1、M2组,G2组插管时间短于其他三组(P<0.05).四组各时点SBP、DBP、HR差异无统计学意义.结论 使用GlideScope并将气管导管弯曲成90°有助于模拟颈椎制动患者的声门暴露,提高插管成功率.     

The clinical assessment of Glidescope in orotracheal intubation under general anesthesia

AIM: The aims of this study were to further evaluate the efficacy and safety of the GlideScope as a device to aid orotracheal intubation, and to further determine whether the GlideScope can provide a better laryngeal view in patients predicted to have a difficult laryngoscopy compared to the Macintosh laryngoscope. METHODS: Ninety-one adult patients, ASA physical status I-II, scheduled for elective plastic and intraoral surgery under general anesthesia requiring orotracheal intubation were included in this study. The laryngeal view was estimated by the classification of Cormack-Lehane and the orotracheal intubation was then performed using a GlideScope. The times required for full visualization of the glottis and for the successful tracheal intubation were recorded, respectively. Noninvasive blood pressure and heart rate were also recorded before (baseline values) and immediately after induction (postinduction values), at intubation and every minute for 5 min after intubation. In patients preoperatively predicted to have a difficult laryngoscopy, the laryngeal views obtained by a GlideScope and a Macintosh laryngoscope were also compared. RESULTS: All patients were successfully intubated using a GlideScope, of which 97% (88/91) required only one attempt. In the patients with successful intubation at one attempt, the times required for full visualization of the glottis and for successful tracheal intubation were 21+/-9 s and 38+/-11 s, respectively. The orotracheal intubation caused significant increases in blood pressure and heart rate compared to the postinduction values, and the maximal values of blood pressure and heart rate during the observation were significantly higher than the baseline values. In 27 patients preoperatively predicted to have a difficult laryngoscopy, the laryngeal views in using the GlideScope were significantly better than those in using the Macintosh laryngoscope. The incidence of minor upper airway trauma was 3.4% in all patients. CONCLUSION: The orotracheal intubation using a GlideScope had advantages of easy and simple operation, excellent laryngeal view, and the ability to provide an improved laryngeal view in the patients with a difficult laryngoscopy. The general anesthesia of clinical standard depth was able to suppress the pressor response, but not temporary tachycardiac response to the orotracheal intubation using a GlideScope.     

Clinical comparison of two stylet angles for orotracheal intubation with the GlideScope video laryngoscope

Study ObjectiveTo compare the success of orotracheal intubation in 62 seconds or less using the GlideScope video laryngoscope (GVL) and a 60° or 90° angled stylet with reverse loading of the endotracheal tube (ETT).DesignProspective, randomized study.SettingOperating room of a university hospital.Patients120 ASA physical status I, II, and III adult patients undergoing elective surgery requiring general anesthesia with orotracheal intubation.InterventionsPatients were randomly allocated to two groups (n = 60 each); both groups received general anesthesia and neuromuscular relaxation. A conventional ETT was styleted and then bent from its straight configuration just above the cuff, either at 60° or 90° against its concave natural curve (reverse loading). Four attending anesthesiologists, who were blinded as to stylet assignment (the 60° or 90° group), intubated the tracheas of all patients with the GVL using either the primary or secondary stylet.MeasurementsThe primary outcome was success of orotracheal intubation in 62 seconds or less. The secondary outcome was actual time to intubation (TTI).Main ResultsThe odds ratio (OR) for intubation success was higher in the 90° group than the 60° group (OR = 10.41; P < 0.03), as evidenced by 59 of 60 patients whose tracheas were intubated successfully within 62 seconds, compared with 51 of 60 patients in the 60° group. Seven of the 9 failures were due to inability of the 60° stylet to reach the glottic opening. The three remaining failures were associated with TTI of more than 62 seconds.ConclusionsThe 90° angled malleable stylet with reverse loading of the ETT provided more reliable ETT delivery to the glottic opening and had a higher success rate than the 60° stylet.     

可视喉镜在新生儿手术气管插管中的应用

目的探讨可视喉镜在新生儿手术气管插管中的应用。方法选择2013-07—2013-12间行新生儿手术50例为研究对象,随机分为可视喉镜组(A组)25例和直接喉镜组(B组)25例,比较两组新生儿气管插管时声门暴露时间,完成气管插管的时间,插管一次成功率和新生儿插管前3 min、插管时及插管后3 min的平均动脉压(MAP)、心率(HR)的变化及插管相关不良反应。结果 A组与B组相比,A组声门暴露时间,完成气管插管的时间均明显缩短,A组插管一次成功率96%,B组插管一次成功率80%,差异有统计学意义。两组新生儿插管前和插管后3 min的MAP和HR比较,差异无统计学意义。但与B组相比,插管时A组新生儿MAP和HR明显降低,差异有统计学意义。A组新生儿插管时不良反应明显低于B组,差异有统计学意义。结论可视喉镜可提高新生儿手术气管插管时成功率,缩短声门暴露时间,气管插管的时间,降低插管不良反应,提高新生儿手术麻醉安全性。     

Tosight视频喉镜用于患儿气管插管的临床研究

目的探讨Tosight视频喉镜用于患儿气管插管的临床效果。方法 70例6～15岁ASAⅠ或Ⅱ级患儿,按气管导管的弯曲角度随机均分为:A组(弯曲为60°)和B组(弯曲为80°)。快速诱导后采用Tosight视频喉镜实施经口气管插管操作,观察记录Tosight视频喉镜喉部显露分级、声门暴露时间、气管插管操作时间、插管次数和并发症的发生情况;记录诱导前(基础值)、诱导后、插管后即刻及插管后1、3、5min的SBP、DBP和HR变化。结果所有患儿均成功完成气管插管操作,其中A组3例患儿改变导管的弯曲角度至80°后插管成功,插管总时间A组明显长于B组(P<0.05)。与基础值比较,插管后即刻、插管后1、3、5min两组SBP明显降低;插管后1min两组HR明显增快(P<0.05)。与诱导后比较,插管后即刻,插管后1、3、5min两组HR明显增快(P<0.05)。两组组间比较插管期间SBP、DBP和HR差异无统计学意义,均无严重并发症。结论 Tosight国产视频喉镜用于6岁以上患儿气管插管,具有操作简单方便、影像清晰、声门暴露好、插管成功率高等优点。其中管芯弯曲80°比60°的插管一次成功率高,插管时间明显缩短。     

Randomized, controlled trial of the double setup tracheal tube during fibreoptic orotracheal intubation under general anaesthesia

Background. Impingement of the tracheal tube (ETT) on upperairway structures during railroading over the fibreoptic bronchoscope(FOB) occurs commonly. Potential complications of impingementinclude prolonged intubation time, leading to arterial desaturation,failed intubation and laryngeal trauma. The objective of thisrandomized, controlled trial was to assess the effect of thedouble setup ETT (a paediatric ETT is placed inside an adultETT) on the incidence of impingement during orotracheal fibreopticintubation. Method. Two hundred patients were randomized to have a singleETT or double setup ETT. After induction of anaesthesia, fibreopticorotracheal intubation was performed. The degree of impingementof the ETT during advancement over the FOB was assessed usinga standardized scoring system based on the manoeuvres requiredto overcome the impingement. Results. The incidence of impingement was lower using the doublesetup ETT compared with the single ETT (18 vs 93%, P<0.001).The double setup ETT also reduced the incidence of impingementrequiring more than a simple 90° counterclockwise rotationto achieve intubation (3 vs 14%, P=0.01) and reduced the medianintubation time (31 vs 35 s, P=0.046). Conclusions. The double setup ETT is effective in reducing ETTimpingement and in reducing intubation time. We did not findan association between ETT impingement and arterial desaturation. Br J Anaesth 2004; 92: 536–40