Truview^(TM) EVO_2光学喉镜和Macintosh直接喉镜显露喉部结构的比较

A comparison of the Truview^(TM) EVO_2 optic laryngoscope with the Macintosh laryngoscope for laryngeal views

目的比较Truview^(TM)EVO_2光学喉镜与Macintosh直接喉镜在经口气管插管中显露喉部结构的效果,探讨该光学喉镜在全麻气管插管中的应用价值。方法经口气管插管全身麻醉下实施择期手术的ASAⅠ～Ⅱ级成人患者200例。麻醉前记录入选患者一般情况和气道评估指标(Mallampati舌咽结构分级、甲颏间距、张口度)。全麻诱导后随机应用直接喉镜或光学喉镜先后显露喉部结构并记录Cormack-Lehane喉部结构显露分级(C/L分级),用后一种喉镜进行气管插管。观察指标包括术前患者一般情况及气道评估指标;C/L分级;喉部结构显露难易度;口咽部损伤;术后咽痛、声音嘶哑等并发症。结果200例患者中男107例,女93例,年龄52岁±13岁,身高164.8 cm±11.3 cm,体重64.0 kg±11.5 kg,甲颏间距6.9 cm±1.1cm,张口度3.7cm±0.5cm。两种喉镜C/L分级均与Mallampati舌咽结构分级具有相关性(P<0.01)。即Mallampati分级越高,C/L分级越高。有91例两种喉镜C/L分级相同,其中76例为Ⅰ级,15例为Ⅱ级;4例喉镜C/L分级优于光学喉镜,余105例则光学喉镜优于直接喉镜;在200例病人中,用直接喉镜C/L分级百分比分别为:Ⅰ级40.O%、Ⅱ级38.5%、Ⅲ级20.5%、Ⅳ级1%;而光学喉镜为:Ⅰ级78.5%、Ⅱ级21.O%、Ⅲ级0.5%。所有患者未记录到明显口咽部损伤和术后咽痛及声音嘶哑。结论Truview^(TM) EVO_2光学喉镜对喉部结构显露C/L分级明显优于Macintosh直接喉镜,从而提示应用光学喉镜可能有助于困难气道的处理。

Objective To evaluate Truview^TM EVO2 optic laryngoscope by comparing with Macintosh laryngoscope, and assess their abilities to provide laryngeal exposure for elective surgical patients requiring tracheal intubation. Methods Two hundred patients, ASA Ⅰ-Ⅱ scheduled for elective surgery under general anesthesia requiring orotracheal intubation were selected. Information was collected including the patient demographics and airway assessment features （ Mallampati oropharyngeal scale, thyromentaz distance and mouth opening）. After induction, the patient＇s glottis was exposed by Truview^TM EVO2 optic laryngoscope or Macintosh laryngoscopes in a random order and recorded the Cormaek - Lehane grade of laryngeal view, respectively. Patient was intubated using the later type of laryngoscope. Parameters were recorded, including age, sex, height, weight, thyromentaz distance, mouth opening, Mallampati oropharyngeal grade, Cormack - Lehane grade, ease of laryngeal view and injury of upper airway . Results There were 200 patients including 107 males and 93 females, age range 52±13 years, height 164.8 cm±11.3 cm, weight 64.0 kg±11.5 kg, thyromental distance 6.9 cm±1.1 cm, mouth opening 3.7 cm±0.5 cm. There was a statistical significance （ P 〈 0.01 ） between Mallampati oropha- ryngeal grade and the Cormack - Lehane grade of laryngeal view with two types of laryngoscope. The Truview^TM EVO2 optic laryngo- scope achieved better laryngeal view than Macintosh laryngoscope did. There were no considerable injuries recorded in all patients. Conclusion Truview^TM EVO2 optic laryngoscope yielded comparable or superior laryngeal view compared with Macintosh laryngoscope. The new type of laryngoscope may have potential advantages for managing the difficult airway.