视频喉镜、直接喉镜和纤维支气管镜经鼻气管插管的临床应用比较

The Clinical Application of Nasotracheal Intubations with GlideScope Videolaryngoscope,Macintosh Direct Larngoscope and Fiberoptic Bronchoscope

目的：比较视频喉镜（GSVL）、直接喉镜（DLS）、纤维支气管镜（FOB）经鼻气管插管的临床应用效果,以便根据患者术前气道评估情况选择最正确的插管方法。方法：150例在经鼻气管插管全麻下行声带息肉摘除术的ASAⅠ~Ⅱ级患者随机分为3组：视频喉镜组（G组,n=50）,直接喉镜组（D组,n=50）,纤维支气管组（F组,n=50）。麻醉前进行气道评估分级（Ⅰ~Ⅳ）,并分别记录麻醉诱导前,麻醉诱导后,气管插管即刻,插管后1min、3min、5min的收缩压（SBP）、舒张压（DBP）、心率（HR）、收缩压与心率的乘积（RPP）以及气管插管成功率、插管时间等。结果：插管即刻、插管后1min的SBP、DBP、HR、RPP等指标升高F组〉D组〉G组,3组相比有显著差异（P〈0.05）。气管插管总成功率分别为98%（F组）、88%（G组）、76%（D组）,3组比较有显著差异（P〈0.05）。气道分级Ⅲ~Ⅳ级的患者插管成功率F组（91.7%）明显高于G组（40%）和D组（0%）（P〈0.05）。插管时间F组（59.3±13.6s）明显长于G组（37.8±9.3s）和D组（36.5±8.8s）（P〈0.05）。结论：视频喉镜经鼻气管插管的血流动力学反应最小,纤维支气管镜法的血流动力学反应大,气管插管成功率最高但耗费时间最长,适合于气道评估分析为Ⅲ~Ⅳ级气道的患者。直接喉镜法气管插管成功率最低,不适合困难气道患者。

Objective：To appraise the clinical application effects of glidescope video laryngoscope,macintosh clirect laryngoscope,fiberoptic bronchoswpe.Methods： A total 150 ASAⅠorⅡpatients undergoing polyp of cord operations under general anesthesia were enrolled and randomly divided into 3 groups： Group G（Glidescope video laryngoscope,n=50）,Group D（Macintosh direct laryngoscope,n=50） and Group F（fiberoptic bronchoscope,n=50）.Airway difficulty prediction（Ⅰ-Ⅳ）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR） and the change of RPP（SBP×HR） were recorded at the beginning of anesthesia induction,at the end of anesthesia induction,and at 0,1,3,5min after tracheal intubation.While the achievement ratio of tracheal intubation and the time of tracheal intubation were recorded.Results： SBP,DBP,HR and RPP at 0,1min after tracheal intubation had significant defferences between the three groups（P0.05）,the achievement ratio of tracheal intubation in the patients of difficulty airway（Ⅰ-Ⅳ） were 98%（Group F）,88%（Group G） and 76%（Group D）（P0.05）.The achievement ratio of tracheal intubation in the patient of airway difficulty prediction（Ⅲ～Ⅳ） were 91.7%（Group F）,40%（Group G） and 0%（Group D）（P0.05）,the time of tracheal intubation in group F（59.3±13.6）s was longer than the time of tracheal intubation in group G（37.8±9.3）s and Group D（36.5±8.8）s,（uP0.05）.Conclusions： The change of haemodynamics is slight when nasal intubation was performed by GSVL、 the change is conspicuous when nasal intubation is performed by FOB,while the achievement ratio of tracheal intubation is higher and the time needed is olnger.So tracheal intubation by FOB is suitable for patients with airway difficulty prediction（Ⅲ-Ⅳ）.Theachievement ratio of tracheal intubation is lower when nasal intubation is performed by DLS,so it is unsuitable for patient with airway difficulty prediction（Ⅲ-Ⅳ）.