可视喉镜联合光棒应用于咽喉部新生物患者的临床可行性分析

目的 观察咽喉部新生物患者采用可视喉镜联合光棒行麻醉气管插管的临床价值。方法 选择2018年12月至2019年3月于复旦大学附属眼耳鼻喉科医院择期行咽喉部新生物全麻手术的患者120例，采用随机数字表法分为可视喉镜组（A组，n=40）、帝视光棒组（B组，n=40）和可视喉镜联合帝视光棒组（C组，n=40）。观察并比较3组患者麻醉诱导前（T₀）、诱导后即刻（T₁）、气管插管后即刻（T₂）和插管后3 min（T₃）的血流动力学指标、首次气管插管成功率、总体插管成功率、插管时间，并同时记录插管期的相关并发症包括有无唇齿、牙龈出血、牙齿松动及口咽喉部出血情况。结果 C组插管时间和首次插管成功例率与B组比较，差异均有统计学意义[（28.9±9.9）s vs.（38.5±12.4）s，40（100%） vs.33（82.5%），P均<0.05]。B组气管插管后即刻（T₂）的平均动脉压低于A组[（79±6）mmHg vs.（101.5±13.3）mmHg]，C组插管即刻的心率高于A组[（102.6±9.3）次/分 vs.（94.2±12.7）次/分]，差异均有统计学意义。T₀、T₁、T₃时间点3组心率、平均动脉压差异均无统计学意义。A组患者中2例出现牙龈少量渗血、1例会厌新生物少量出血，并发症发生率为7.5%。B组患者无明显并发症。C组患者有1例出血牙龈少量渗血，并发症发生率为2.5%。结论 联合使用可视喉镜和光棒，制定个性化的插管方案，可以发挥不同气道工具的优势，提高咽喉部新生物患者的插管成功率，缩短插管时间，减少并发症的发生。

Clinical feasibility of combined videolaryngoscopy and disposcope endoscope in patients with pharyngeal neoplasm

Objective To investigate the clinical feasibility of combined videolaryngoscopy and Disposcope endoscope in patients with pharyngeal neoplasm. Methods One hundred and twenty patients with pharyngeal neoplasm admitted to Department of Head and Neck Surgery,Eye,Ear,Nose and Throat Hospital of Fudan University between Dec 2018 and Mar 2019 were randomly divided into videolaryngoscopy group (group A,n=40),disposcope endoscope group (group B,n=40) and disposcope endoscope+videolaryngoscopy group (group C,n=40).Heart rate (HR),mean arterial pressure (MAP) at T₀(before anesthesia),T₁(after drug administration),T₂(after tracheal intubation),T₃ (3 minute after tracheal intubation),the first-attempt success rate of tracheal intubation,total success rate of tracheal intubation intubation time and intubation-related complications were recorded. Results The intubation time of group C was significant short[(28.9±9.9)s vs. (38.5±12.4)s,P<0.05],and the first-attempt success rate was significant high in group C compared to group B (100% vs. 82.5%, P<0.05).The MAP at T₂ is significant lower in group B compared to group A[(79±6)mmHg vs. (101.5±13.3)mmHg,P<0.05],and the HR at T₂ was significant higher in group C compared to group A[(102.6±9.3)bpm vs. (94.2±12.7) bpm,P<0.05].No significant difference in HR and MAP at other time points.Two patients with mild teeth bleeding and 1 patient with mild bleeding of the epiglottis neoplasm were in group A,and the complication rate was 7.5%.No complication was found in group B.In gourp C,1 patient with mild teeth bleeding was recorded,and the complication rate was 2.5%. Conclusion Disposcope endoscope and videolaryngoscopy used in combination to make a personalized intubation may synergistic effectively improve the success rate of intubation in patients of patients with pharyngeal neoplasm, provide more stable hemodynamics,shorter intubation time and fewer complications.