Macintosh直接喉镜充分暴露声门对第1至第4颈椎椎体相对位置的影响

Relative motion between each segment of cervical vertebrae after trachea intubation with Macintosh direct laryngoscopy

目的：定量研究Macintosh直接喉镜充分暴露声门时颈椎各椎体之间相对位置的变化.方法：选择经口气管插管全身麻醉下行择期手术的患者11例,全麻诱导且充分肌松后用C臂X线摄片机拍摄颈部侧位片,然后使用Macintosh直接喉镜（3号镜片）充分暴露声门后再次拍摄患者颈部侧位片并插入气管导管.测量第1颈椎与枕骨及第1颈椎～第4颈椎各相邻椎体之间的角度,并比较插管前、后各相邻椎体之间角度的变化.结果：Macintosh直接喉镜气管插管可导致第1颈椎与枕骨及第1颈椎与第2颈椎椎体之间的成角较插管前发生显著变化,但插管前、后第2颈椎与第3颈椎及第3颈椎与第4颈椎椎体之间的角度变化差异无统计学意义.结论：Macintosh直接喉镜行气管插管可导致寰椎与枕骨及寰枢椎椎体之间的相对位置发生显著变化,但枢椎与第3颈椎及第3颈椎与第4颈椎椎体之间的相对位置变化并不明显.

Objective： To quantify the relative motion between each segment of cervical vertebrae after trachea intubation with Macintosh direct laryngoscopy. Methods： Eleven patients underwent elective surgery requiring general anesthesia and orotracheal intubation were included. After anesthesia induction and complete muscle relaxation, intubation was performed with a Macintosh direct laryngoscope （3 # blade）. Lateral cervical radiograph was taken by a C-arm X-ray machine before and after laryngoscopy. Angles between C1 vertebra and the occipital bone, and also between each segment of cervical vertebrae from C1 to CA were measured and compared before and after intubation. Results： There was significent difference angles between C1 vertebrae and occipital bone, relative motion between C1 and C2 vertebrae after intubation were significantly larger than those before intubation. But angles between CZ and C3, C3 and C4 after intubation were similar to those before intubation. Conclusion： Trachea intubation with Macintosh direct laryngoscope results in a relative motion between atlas and occipital bone, as well as between atlas and axis, hut not between C2 and C3, C3 and CA.