颈前光斑法和视频法在Clarus可视管芯引导气管插管学习中的比较

目的比较视频法和颈前光斑法两种操作技术对Clarus可视管芯(Clarus Video System, CVS)引导气管插管学习曲线的影响。方法以能熟悉运用直接喉镜但无Clarus可视管芯运用经验的第一或二年的麻醉科住院医师共10名为操作者,随机分为两组,分别运用颈前光斑法和视频法对择期全麻手术患者进行CVS插管。记录每个学员首个25例患者气管插管情况,用累积和(cumulative sum,CUSUM)方法建立学习曲线,运用累积和分析法算出掌握相应插管技术所需的最少例数。记录插管时间,插管成功率,两组导管沾染少量血迹和轻度咽喉痛等插管相关不良反应发生情况。结果视频法操作组掌握行CVS插管技术最少需要17例,颈前光斑组为11例,明显少于视频法操作组(P0.05)。颈前光斑操作组学员在学习曲线平台期后的插管中位时间为28.30 s,视频法操作组为28.26 s,两组差异无统计学意义。两组学员插管后发生导管沾染少量血迹和轻度咽喉痛等插管相关不良反应差异无统计学意义。结论运用Clarus可视管芯行气管插管是一项学习曲线短、操作上手快、损伤小的实用性技能。对于正常气道,采用颈前光斑技术时Clarus可视管芯的学习曲线优于视频法。

Comparison of transillumination technique and video-monitoring technique for intubation in the learning curve of the Clarus Video System

Objective To evaluate the effects of transillumination technique and video-monitoring technique for intubation in the learning curve of Clarus Video System (CVS).
Methods Ten novice practitioners qualified as an anesthetist for less than or equal to 2 years, who are familiar with the use of laryngoscope but has no CVS experience, were randomly assigned into transillumination group and video-monitoring group. The situation of endotracheal intubation for the first 25 patients of each novice was recorded, and the learning curves were established using the cumulative sum (CUSUM) method and the functional equations were calculated according to the polynomial fit technique. In addition, time of intubation, success rate and incidence of intubation-related intraoral injury were recorded.
Results Video-monitoring group required at least 17 cases to complete the learning curve, while 11cases for transillumination group. The learning curve of transillumination group was better than that of video-monitoring group (P<0.05). There were no significant differences between the two groups in the time of intubation after the curve peak which was 28.30 s in transillumination group and 28.26 s in video-monitoring group. There were no significant differences between the two groups in the incidence of intubation-related intraoral injury (tube stained with blood and sore throat).
Conclusion Intubating with Clarus Video System, a useful skill with short learning curve, is easy operation and less damage. For normal airway, the learning curve of Clarus Video System using transillumination method is better than using video-monitoring method.