GlideScope视频喉镜和直接喉镜经口气管插管对血流动力学影响的比较性研究

Comparison of Hemodynamic Responses to Orotracheal Intubation with GlideScope Videolaryngoscope and Macintosh Direct Laryngoscope

目的：对比观察Macintosh直接喉镜和GlideSeope视频喉镜经口所管插管对血流动力学的影响。方法：选择57例ASAⅠ-Ⅱ，年龄18-60岁和拟在经口气插管全身麻醉下放择期整形外科手术的患者，随机分为GlideScope视频喉镜组（GSVL组，30例）和Macintosh直接喉镜组（MDLS组，27例）。麻醉诱导后分别采用GlideScope视频喉镜或Macintosh直接喉镜实施经口气管插管操作，观察两组患者麻醉诱导前、后、气管插管时和气管插管后5min内的血压、心率（HR）和二重指数（RPP）的变化，并记录气管插管时间。结果：GSVL组患者的气管插管时间明显长于MDLS组。麻醉诱导后，两组患者的血压和RPP均较麻醉诱导前明显降低。与麻醉诱导后盯比较，气管插管引起两组患者的血压，HR和RPP明显升高。除了GSVL组患者观察期的DBP最大值之外，气管插在两组患者引起的血压升高均未明显超过麻醉诱导前水平。与麻醉诱导前相比较，GSVL组患者气管插管时的HR和RPP明显升高，并且HR增快持续了4min；虽然MDLS组患者气管插管时的HR亦明显高于麻醉诱导前，但是HR增快仅持续了1min，两组患者在所有观察时间点的血流动力学指标均无明显差异。结果：采用GlideScope视频喉镜和Macintosh直接喉镜实施经口气管插管可引起类似的血流动力学反应，GlideScope视频喉镜在减轻经口气管插管血流动力学反应方面并不优于Macintosh直接喉镜。

Objective： To compare the hemodynamic responses to orotracheal intubagon using a GlideScope videolaryngoscope（GSVL）and a Macintosh direct taryngoscope （MDLS） Method：57 patients ASA physical status Ⅰ-Ⅱ, aged 18450 years,scbeduled ;or elective plastic surgery under general anesthesia requinng orotracheal intubation were randomly allocated to edber the GSVL group or the MDLS group. After an intravenous anesthetic induction, the orotracheal intubagon was performed using a GSVL or a MDLS respectively Noninvasive blood pressure and HR were recorded before and after anesthetic induction,at intubation and 5 minutes after intubagon with 1-minute interval and was also noted the intubation time Rate-pressure product（RPP）were calculated. Results： The inlubaPon time in GSVL group was significantly longer than in MDLS group After anesthetic induction, blood pressures and RPP in the two groups decreased significantly compared to their preinduction values. As comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in blood pressures, HR and RPP. Except for maximal value of DBP in GSVL group, the rise of blood pressures caused by orotracheal intubation in both groups did not exceed their baseline values. In GSVL group, HR and RPP at intubation were significantly higher than their baseline values, and increase in HR lasted for 4 min. In MDLS group, HR at intubation were also significantly higher than its baseline value, but increase in HR lasted only for 1 min. There was no significant difference in the hemodynamic data at any time point during the observation between the two groups. Conclusions： The hemodynamic responses to orotracheal intubation using a GSVL and a MDLS were similar. As compared with MDLS, GSVL does not provide any special advantages in prevention of the adverse hemodynamic responses to orotracheal intubation.