嗅物位和简单头后仰位对喉镜显露的比较性研究

目的比较嗅物位和简单头后仰位对喉镜显露和气管插管的影响。方法200例在全麻下行择期手术患者随机分为两组，Ⅰ组：第1次喉镜显露用嗅物位，第2次用简单头后仰位；Ⅱ组：第1次喉镜显露用简单头后仰位，第2次用嗅物位。用Cormack Lehane分级法评估喉镜显露情况；用困难气管插管评分（IDS）评估气管插管难易程度；最后研究嗅物位时喉镜显露的相关因素。结果两组患者CormackLehane评分和困难气管插管评分比较无统计学意义（P〉0．05）。胸颏间距〈12cm、Mallampati评分Ⅲ和Ⅳ级、BMI〉30kg／m^2和颈活动〈35°同嗅物位时喉镜显露密切相关（P〈0．05）。结论气管插管时常规使用嗅物位对简单头后仰位并无明显优势，但在有导致困难气道的危险因素存在时可改善喉镜显露，从而提高插管成功率。

Comparison of the sniffing position with simple head extension for laryngoscopic view in elective surgical patients

Objective To evaluates sniffing position and simple head extension for glottie visualization during direet la-ryngoscopy in elective patients undergoing general anaesthesia. Method 200 adult patients posted for elective surgery under general anaesthesia were studied. Anaesthetic procedure included two laryngoscopies. Head position was randomized as Group Ⅰ (n= 100) in the sniffing position during first laryngoscopy and in extension during second. Group Ⅱ(n= 100) was in extension during first laryngoscopy and sniffing position during the second. Glottie visualization was assessed by Cormaek Lehane classifica-tion. Intubation difficulty scale assessed intubation difficulty. Association of predictive factors like interincisor gap, thyromental distance, Stemomental distanee ete with improvement of laryngoscopic view using sniffing position was studied. Results The Cormack grade distribution and intubation difficulty scale were not significantly modified between the two groups. Conditions known to cause difficult intubation like obesity, restricted neck movement, short neck, Mallampati class Ⅲ and Ⅳ were related to improvement in laryngoscopic view with application of the sniffing position. Conclusion Routine use of the sniffing position appears to provide no significant advantage over simple head extension for tracheal intubation in this setting. The sniffing position appears to be advantageous in obese and head extension-limited patients sniffing position is beneficial especially in presence of conditions known to cause difficult intubation.