探讨GlideScope视频喉镜在临床麻醉中行气管插管的可行性

Applicability of GlideScope Video Laryngoscope for Tracheal Intubation in Clinical Anaesthesia

目的探讨GlideScope视频喉镜在临床麻醉中行气管插管的可行性。方法选择首都医科大学附属复兴医院妇产科就诊的经口气管插管全身麻醉下行妇科腹腔镜手术的患者100例,ASAⅠ～Ⅱ级,分为2组,即:Ⅰ组(G),Ⅱ组(M),年龄(45±15)岁,常规麻醉诱导〔芬太尼(2～3)μg.kg-1,异丙酚2 mg.kg-1,维库溴铵0.1 mg.kg-1〕。Ⅰ组采用GlideScope视频喉镜,Ⅱ组采用直接喉镜实施经口气管插管。记录显露声门时间、插管时间、喉部显露情况及麻醉诱导气管插管期间不同时间点(T1、T2、T3、T4)平均动脉压(MAP)、心率(HR)。结果 G组满意显露声门的时间为(15.38±5.21)s;M组为(14.21±3.11)s。G组气管插管的时间为(30.22±11.31)s;M组为(30.11±12.23)s。2组麻醉诱导气管插管期间与基础值T1比较,T2及T3时段MAP降低(P<0.05),T4时段心率增加显著(P<0.05),2组间差异无统计学意义(P>0.05)。结论 GlideScope视频喉镜在临床麻醉中行气管插管过程中能安全有效地显露声门,气管插管刺激及损伤较小,能解决部分临床困难气管插管问题并可减少医生交叉感染的危险。

Objective To explore applicability and safety of GlideScope video laryngoscope for tracheal intubation in clinical anesthesia. Methods One hundred ASAⅠ~Ⅱ patients,aged（45±15） years,were randomly assigned into 2 groups（n=50 each）,scheduled for gynaecological laparoscopic surgery under general anesthesia（group G） with tracheal intubation.Anaesthesia was induced with fentanyl 2~3 μg·kg-1,propofol 2 mg·kg-1,vecuronium 0.1 mg·kg-1 and maintained with 1% isoflurane.Orotracheal intubation with GlideScope video laryngoscope was performed for group Ⅰ patients at 3 min after intravenous vecuronium;Group Ⅱ patients were intubated by direct laryngoscopy using Macintosh（group M）.The glottic exposure time and the tracheal intubation time were recorded.The BP and HR were recorded before and after induction of anesthesia during tracheal intubation. Results The glottic exposure time was（15.38±5.21）s in the group G and（14.21±3.11）s in the group M.The mean tracheal intubation time was（30.22±11.31）s in the group G and（30.11±12.23）s in the group M.The BP was significantly decreased after induction of anesthesia,but HR was significantly increased during tracheal intubation in both groups. Conclusion GlideScope video laryngoscope achieved better glottic exposure with less tracheal irritation and damage.The method may reduce the risk of cross-infection to doctors.