光棒与直接喉镜在老年择期手术患者气管插管麻醉中的效果比较

Comparison between the Lightwand and the Direct Laryngoscope during Oral Tracheal Intubation in Elderly Patients

目的:比较光棒与直接喉镜对老年择期手术患者气管插管麻醉的血流动力学与气道并发症的影响。方法:选择100例ASAⅠ～Ⅱ级全麻择期手术患者,气道评估为Ⅰ～Ⅲ级,年龄为62～76岁,随机均分为光棒组和喉镜组。光棒组采用光棒引导气管插管,喉镜组采用普通喉镜下直视气管插管。两组患者采用相同的全身麻醉诱导方法,分别记录麻醉诱导前(T0)、麻醉诱导后(T1)、插管即刻(T2)、插管后1 min(T3)、插管后3 min(T4)的SBP、DBP、SpO2和HR。记录1次插管成功的例数、2次插管成功的例数和插管时间。观察插管后有无口腔、咽喉黏膜、牙齿及牙龈的损伤,术后随访有无咽喉疼痛和声音嘶哑的发生。结果:喉镜组在T2、T3时间点的SBP、DBP和HR明显高于T1时(P<0.05);T2、T3时间点的SBP、DBP和HR,喉镜组较光棒组明显升高(P<0.05);一次插管成功的例数光棒组明显高于喉镜组,插管时间光棒组较喉镜组明显缩短(P<0.05)。口腔、咽喉黏膜、牙齿、牙龈的损伤等术后并发症,光棒组明显低于喉镜组(P<0.05)。结论:光棒气管插管对血流动力学影响较轻,气道并发症发生率低,光棒是一种损伤轻、安全、有效的插管工具。

Objective To compare the hemodynamic changes and the injuries to the oral cavity and throat during oral tracheal intubation with the Lightwand or the direct laryngoscope in elderly patients.Methods One hundred patients,ASA Ⅰ~Ⅱ,aged 62~76 years,scheduled for surgery under general anesthesia with oral tracheal intubation,were randomly divided into two groups: the Lightwand group and the direct laryngoscope group.General anesthesia in all two groups were induced with same methods.SBP,DBP,SpO2 and HR were recorded at 5 time points: before anesthysia induction(T0),after anesthysia induction(T1),immediately after intubation(T2),1 minute(T3) and 3 minute(T4) after intubation.The successful cases with one intubation or two incubation and the incubation time were recorded.The injuries of oral mucosa,throat mucosa,tooth and gum were observed after incubation.The incedence of pharyngodynia and cerchnus after operation were also recorded.Results Compared with that at T1 point,SBP,DBP and HR at T2 and T3 points in the direct laryngoscope group were significantly increased(P<0.05).Compared with the lightwand group,the SBP,DBP and HR in the direct laryngoscope group were significantly increased at T2 and T3(P<0.05).The sucessful cases with one incubation in the lightwand group were more than those in the direct laryngoscope group(P<0.05).The time of incubation in the lightwand group were significantlly less than that in the direct laryngoscope group(P<0.05).Compared with the direct laryngoscope group,the incidence of postoperative complication,such as oral throat mucosa injury,tooth and gingival injury,were significanlty decreased in the lightwand group(P<0.05).Conclusion Incubation with lightwand can attenuate the haemodynamics changes,decrease the incidence of airway complication.Lightwand is a safe and valid incubation tool.