Shikani喉镜左侧磨牙入路和直接喉镜经口气管插管对血流动力学的影响

Comparison of hemodynamic responses to orotracheal intubation with Shikani optical stylet through the left molar approach and Macintosh direct laryngoscope

目的比较Shikani喉镜(SOS)左侧磨牙入路和Macintosh直接喉镜经口气管插管对血流动力学的影响。方法 40例全麻下择期手术患者,随机均分为SOS左侧磨牙入路气管插管组(S组)和Macintosh直接喉镜插管组(M组)。观察两组患者麻醉诱导前(T0)、诱导后(T1)、气管插管即刻(T2)和气管插管后1min(T3)、3min(T4)、5min(T5)的BP、HR,并计算SBP×HR(RPP),记录气管插管时间。结果与T0时比较,T1时两组患者的BP和RPP均明显降低(P<0.05);与T1时比较,T2、T3时两组患者的BP和RPP升高,T2～T5时两组患者HR明显增快(P<0.05)。T2时S组SBP明显低于M组(P<0.05)。与S组比较,M组气管插管开始后HR出现最大值的时间明显后延。观察期S组和M组SBP大于基础值30%的发生率和RPP大于22000的发生率差异无统计学意义。两组患者的气管插管时间差异无统计学意义。结论 SOS左侧磨牙入路可简便有效地用于经口气管插管操作;与Macintosh直接喉镜比较,SOS左侧磨牙入路可引起较轻的血流动力学反应。

Objective To compare the hemodynamic respon orotracheal intubation using Shikani optical stylet （SOS）and a Macintosh direct laryngoscope （MDLS）. Methods Forty patients scheduled for selective surgery under general anesthesia were randomly allocated to either group S or group M. Invasive blood pressure and HR were recorded before anesthesia induction（T0）, after induction（T1 ）, immediately after intubation（T2 ） and at 1 min（T3 ）, 3 min（T4 ）, 5 min（T5 ） after intubation. The intubation duration was recorded, and rate-pressure product（RPP）was calculated. Results After induction,BP and RPP in both groups decreased significantly （P〈0.05）. Compared with T1 ,BP and RPP at T2 ,T3and HR at T2-T5 increased significantly （P〈0.05）. At T2, SBP in group M was higher than that in group S（P〈0. 05）. Except for this, no significant difference was detected between two groups. In group M, the time required for the maximum values of HR was significantly delayed compared with that in group S. The incidence of SBP more than 30% of the baseline and RPP more than 22 000 in two groups was not significantly different. There was no significant difference in intubation duration. Conclusion Orotracheal intubation with SOS via left molar approach can be performed effectively less with less hemodynamic response.