GlideScope视频喉镜下经鼻与经口气管插管在困难气道患者中的比较

 目的 比较在困难气道中使用GlideScope视频喉镜(GlideScope videolaryngoscope，GVL)经口与经鼻气管插管的效果。方法 60例行择期神经外科手术的患者随机均分为GVL经口气管插管组和GVL经鼻气管插管组。麻醉诱导后，所有患者均采用硬质费城颈托固定颈部，模拟困难气道。比较两种方法的气管插管时间、困难插管评分、总的插管成功率、试插的次数及插管并发症。结果 与经口气管插管比较，GVL经鼻气管插管的时间较短(49 s vs. 38 s，P<0.01)，且插管难度降低。但两组总的插管成功率及试插次数相似。两组均无误入食管以及缺氧情况发生，但经鼻气管插管组的鼻出血发生率较高(28% vs. 7%，P=0.042)。结论 在困难气道中，GVL经鼻气管插管较GVL经口气管插管快速、容易，但经鼻插管的鼻出血发生率较高。

Effectiveness of orotracheal intubation and nasotracheal intubation with a GlideScope videolaryngoscope in patients with simulated difficult airways

Objective To compare the effectiveness of orotracheal intubation (OI) and nasotracheal intubation (NI) with the GlideScope videolaryngoscope (GVL) conducted in patients with simulated difficult airways. Methods Sixty patients requiring intubation for elective neurosurgery were randomly allocated to either OI group (n=30) or NI group (n=30) with the GVL. After anesthesia induction and muscle relaxation,patients′ necks were stabilized with rigid Philadelphia collars. The time to intubation (TTI), intubation difficulty scale (IDS) score (the ease of intubation), overall intubation success rate, the number of attempts required for successful intubation and airway complications were recorded. Results The TTI of NI with the GVL was shortened by 11 s compared with OI (49 s vs. 38 s, P<0.01). Nasotracheal intubation with the GVL was easier than orotracheal intubation. Overall intubation success rates were 97% in NI group and 87% in OI group. The number of required intubation attempts was similar with each route. Neither esophageal intubation nor hypoxia occurred. While the incidence of bleeding in NI group was higher than that in OI group. Conclusions Compared with OI, NI with the GVL results in a faster, easier and more effective intubation in patients with difficult airways when a rigid collar is used except nasotracheal intubation with more bleeding.