Glidescope视频喉镜在全身麻醉小儿经口气管插管中的应用

Application of Glidescope Video-Laryngoscope in Children Undergoing General Anesthesia

目的探讨Glidescope视频喉镜(GSVL)在全身麻醉小儿经口气管插管中的实用性。方法选择33例符合美国麻醉医师协会Ⅰ、Ⅱ级需经口气管插管全身麻醉下实施择期外科手术的患儿,术前进行全面的呼吸道评估。在常规全身麻醉诱导后,分别采用Macintosh喉镜和GSVL在有、无喉外部压迫操作时进行喉部显露操作,记录有、无喉外部压迫操作时的最佳Cormack和Lehane喉部显露分级、最佳喉部显露的时间。在GSVL喉部显露操作下实施经口气管插管操作,记录采用GSVL成功完成气管插管的时间、试操作的次数、成功和失败的发生率。结果Macintosh喉镜和GSVL的最佳喉部显露时间分别为(5.9±3.2)s和(6.1±3.4)s,二者比较无显著差异(t=0.25P>0.05)。在有和无喉外部压迫操作的情况下,采用Macintosh喉镜获得的Cormack和Lehane喉部显露分级有显著性差异(Z=3.55P<0.01),采用GSVL获得Cormack和Lehane喉部显露分级亦有显著性差异(Z=4.15P<0.01)。但在均有和均无喉外部压迫操作的情况下,采用Macintosh喉镜和GSVL获得的喉部显露分级均无显著差异(Z=1.25,1.28Pa>0.05)。33例小儿中GSVL经口气管插管在31例经1次试操作获得成功,2例经2次试操作获得成功。完成经口气管插管所需的时间为20～51(30.0±7.9)s。结论在小儿喉部显露和经口气管插管时,GSVL与Macintosh喉镜一样实用。在小儿采用GSVL实施经口气管插管时,带插管芯气管导管的前端应被塑型成70～80度角,并应将喉外部压迫作为一种常规操作。

Objective To explore the practicability of the Glidescope video-laryngoscope（GSVL） in orotracheal intubation in children undergoing general anesthesia.Methods Thirty-three children who were accorded American Society of Anesthesiologists physical status grade Ⅰ,Ⅱ and need undergoing elective surgery and requiring orotracheal intubation were studied.Before surgery,a full-scale evaluation of the airway was performed in all patients.After standard anesthesia induction,laryngeal exposure was performed with the Macintosh laryngoscope and the GSLV,respectively,with and without external laryngeal manipulation（ELM）.The optimal Cormack and Lehane laryngeal exposure scale with and without ELM,and the time required for the optimal laryngeal exposure were recorded.Then the orotracheal intubation was done under the laryngeal view of the GSLV.The time required to achieve tracheal intubation,the attempt times for the successful intubation,and incidences successful and failed intubation were also recorded.Results When the Macintosh laryngoscope and GSLV were used,the time required for optimal laryngeal exposure were（5.9±3.2） s and（6.1±3.4） s,respectively,without significant difference between them（t=0.25 P〉0.05）.The Cormack and Lehane laryngeal exposure grades obtained by the Macintosh laryngoscope with and without ELM were significantly different（Z=3.55 P〈0.01）.The Cormack and Lehane laryngeal exposure grades obtained by the GSLV with and without ELM also differed significantly（Z=4.15 P〈0.01）.However,there was no significant difference in the Cormack and Lehane laryngeal exposure grades all with and all without ELM between the 2 tools（Z=1.25,1.28 P_a〉0.05）.Of all 33 pediatric patients,successful orotracheal intubation using the GSLV was completed by one attempt in 31 patients and by 2 attempts in 2 cases.The time required to achieve successful tracheal intubation was 20-51（30.0± 7.9） s.Conclusions GSLV is as useful as Macintosh laryngoscope for laryngeal exposure and orotracheal intubation in children.When the orotracheal intubation is done using the GSLV in children,the distal end of a styletted endotracheal tube should be bent anteriorly to an angle of 70-80 degrees and ELM is routinely used.