GlideScope视频喉镜和Macintosh直接喉镜在经口气管插管应用中的对比研究

A comparative study of Oro-tracheal intubation with glidescope videolaryngoscope and Macintosh direct laryngoscope

目的:比较GlideScope视频喉镜和Macintosh直接喉镜在经口气管插管应用中的优缺点。方法:对20例择期妇科或普外科病人,予术前行常规气管插管困难程度评估。全麻诱导后先后采用Macintosh直接喉镜和GlideScope视频喉镜行喉部显露,评估声门的Cormack分级,再行气管插管。结果:采用GlideScope视频喉镜后20例病人均在显示器上清晰显示声门,Cormack分级:Ⅰ级为18例,Ⅱ级为2例;采用Macintosh直接喉镜组Cormack分级Ⅰ级为6例,Ⅱ级为12例,Ⅲ级为2例。与Macintosh直接喉镜组比较,GlideScope视频喉镜组的Cormack分级显著低(P<0.01),Cormack分级Ⅰ级显露率(90%vs30%)显著高(P<0.01)。GlideScope视频喉镜组和Macintosh直接喉镜组显露声门的时间分别为(25±14)s和(27±19)s,组间比较无显著意义。GlideScope视频喉镜组经口气管插管成功率为100%,但各有1例病人分别重复插管2次和3次才取得成功,原因为气管导管置入口腔变形,无法将气管导管对准声门。结论:GlideScope视频喉镜用于临床经口气管插管具有操作简单、改善Cormack分级、声门显露清晰等优点,但气管导管通过口咽拐角处困难是其缺点。

Objective：To compare the advantages and disadvantages of orotracheal intubation using Glidescope videolaryngoscope （GSWL） and Macintosh direct laryngoscope （MDLS）. Methods： 20 ASA Ⅰ - Ⅱ patients, elective gynecology or common surgery, under general anesthesia with orotracheal intubation, routinely received the preoperative airway assessments to predict the difficulty of tracheal intubation. After anesthesia induce, all patients received a Cormack grade under MDLS and GSVL in order, then orotracheal intubatien under GSVL. Results： Cormack grade Ⅰ of GSVL and MDLS group was 18 vs 6, grade Ⅱ ：2 vs 12, grade Ⅲ ：0 vs 2.Compared with MDLS group, Cormack grade was markedly lower and the rate of grade I was significant higher in GSVL group （90% vs30%） .The exposure time of glottis （GSVL vs MDLS： 25 ± 14s vs 27 ± 19s）had no significance in the two groups. The achievement ratio of orotracheal intubation in GSVL group was 100%, with second intubation in one patient and third try in another. Conclusion： Orotracheal intubation using GSVL peovides a clear view of glottic, improves Cormack grade and is simple to perform. But it is slightly hard for endotracheal to pass the corner of oropharynx in GSVL group.