视频喉镜和头部可控气管导管用于困难气道经口气管插管的临床研究

目的:评价在视频喉镜下使用头部可控气管导管在困难气道经口气管插管中的应用,观察其可操作性和临床应用价值。方法:术前评估为困难气道择期外科手术患者33例,ASAⅠ或Ⅱ级,随机分为3组:M组、G1组和G2组,每组各11例,常规麻醉诱导后,M组用Macintosh直接喉镜和普通气管导管,G1组采用Glidescope视频喉镜和普通气管导管,G2组采用Glidescope视频喉镜和头部可控气管导管,实施经口气管插管。分别记录采用Macintosh直接喉镜和Glidescope视频喉镜喉部显露Cormark-Lehane分级、气管插管操作时间和插管成功率和一次成功率。结果:与M组相比,G1组和G2组Cormark-Lehane分级中Ⅰ和Ⅱ级的例数显著增多(P<0.05);G1组和G2组插管时间明显缩短(P<0.05),其中G2组插管时间明显缩短于G1组(P<0.05);G1组和G2组插管成功率显著增加(P<0.05),插管一次成功率G2组明显高于G1组(P<0.05)。结论:采用Glidescope视频喉镜实施经口气管插管具有喉部显露清晰、损伤小和降低气管插管难度等优点,配合使用头部可控导管使操作更容易。

The Clinical Application of Orotracheal Intubation in Difficult Airway with Glidescope Videolaryngoscope and Tracheal Tube with Controllable Tip

Objective:To introduce the clinical experience of the application of orotracheal intubation in difficult airway with GlideScope videolaryngoscope and tracheal tube with controllable tip and to observe its maneuverability and clinical application value. Methods:Thirty-three patients with ASAⅠorⅡscheduled for elective surgery and with difficult airway by predicting before operation were randomly divided into three groups(n=11):M group,G1 group and G2 group.After a routine anesthetic induction,Orotrachal intubation was performed with Macintosh direct laryngoscope and ordinary tracheal tube or Glidescope videolaryngoscope and ordinary tracheal tube or Glidescope videolaryngoscope and tracheal tube with controllable tip.The time of tracheal intubation,the number of times of tracheal intubation and the Cormack-Lehane grade were recorded by using GlideScope videolaryngoscope and Macintosh direct laryngoscope. Results:The Cormack-Lehane grade was significantly lower with GlideScope videolaryngoscope than with Macintosh direct iaryngoscope(P<0.05);Tracheal intubation time was significantly shorter in G1 group and in G2 group than in M group(P<0.05);Tracheal intubation time was significantly shorter in G2 group than in G1 group(P<0.05);The success rate of tracheal intubation was significantly higher in G1 group and in G2 group than in M group(P<0.05);The first success rate of tracheal intubation was significantly higher in G2 group than in G1 group(P<0.05). Conclusions:The orotracheal intubation with GlideScope videolaryngoscope is easy performance,little injury and clear visualization for the glottis.It is easier performance with GlideScope videolaryngoscope and tracheal tube with controllable tip.