Airtraq喉镜与Macintosh喉镜临床应用的比较

A comparison between Airtraq laryngoscopy and Macintosh laryngoscope in clinical application

目的比较Airtraq喉镜和Macintosh喉镜经口气管插管的临床效果和插管对血流动力学的影响。方法 90例ASAⅠ或Ⅱ级、实施择期整形外科手术的患者,随机分为Airtraq喉镜组(n=45)和Macintosh喉镜组(n=45),常规麻醉诱导后分别采用Airtraq喉镜和Macintosh喉镜进行气管插管操作,观察记录两组的声门暴露情况、插管时间、插管成功率以及并发症的发生情况;并记录麻醉诱导前、诱导后、气管插管时以及插管后1 min、3 min和5 min的收缩压(SBP)、舒张压(DBP)、心率(HR)和心率-收缩压乘积(RPP)的变化。结果 Airtraq喉镜组的声门暴露均为Cormack-Lehane I级,Macintosh喉镜组则有5例Ⅱ级,1例Ⅲ级;Airtraq喉镜组和Macintosh喉镜组的插管一次、二次插管成功率分别是95.6%、86.7%和100%、97.8%;Airtraq喉镜组暴露会厌时间和插管总时间均显著长于Macintosh喉镜组(P<0.05)分别为14.4±6.5 s、32.7±12.3 s和7.7±3.6 s、24.9±6.3 s;与麻醉诱导前相比,两组诱导后的各项血流动力学指标较诱导前均明显下降(P<0.05);与麻醉诱导后相比,Airtraq喉镜组插管时及插管后各时点血流动力学指标无显著性变化(P>0.05),Macintosh喉镜组的HR和RPP则显著升高(P<0.05),组间比较有统计学意义。结论与Macintosh喉镜相比,应用Airtraq喉镜插管可以改善声门的暴露情况、提高气管插管的一次成功率、减轻气管插管的血流动力学变化,但气管插管时间明显延长。

Objective To compare the clinical effects and hemodynamic responses to tracheal intuhation with Airtraq laryngoscopy and Macintosh laryngoscopy. Methodss Ninety ASh Ⅰ - Ⅱ patients scheduled for elective plastic surgery under general anesthesia were prospective randomized allocated into 2 groups （n = 45 for each） ： the Airtraq laryngoscopy group （group A） and the Macintosh laryngoscopy group （Stoup M）. After rapid intravenous induction, the patients in each group were orally intubated with Airtraq laryngoscope or Macintosh laryngoscopy respectively. In group A and M, glottie exposure view, intubation time, success rate, postoperative complications and haemodynamics changes were recorded. And the changes of systolic blood pressure （ SBP）, diastolic blood pressure （DBP） , heart rate （ HR）, and rate - pressure - product （RPP） were also recorded before anesthesia induction, after anesthesia induction, during intubation, and intubation after 1 minute, 3 minutes, 5 minutes. Results By the Cormack＇s classification, all the patients in group A had the laryngeal exposure of grade Ⅰ, while 5 patients in group M had grade Ⅱ and 1 patient had grade Ⅲ. The first time intubation probability of success was 95.6% , in group A and was 86.7% in group M. And the second time intubation probability of success was 100% in group A and was 97.8% in group M. Epiglottis exposure time, intubation time in group A （14.4 ±6.5 s,32.7 ±12.3 s） were significantly long than that in group M （7.7 ±3.6 s,24.9 ±6.3 s） （ P 〈0.05）. The hemodynamic parameters （SBP, DBP, HR, and RPP）after anesthesia induction had remarkable decrease compared with those before anesthesia induction in two groups. Compared with after anesthesia induction, there were no significant changes of the hemodynamic parameters during intubation, and in- tubation after certain minutes in group A （ P 〉 0.05 ）. Compared with after anesthesia induction, there were a remarkable increase of HR and RPP during intubation, and intubation after certain minutes in group A （ P 〈 0.05）. Conclusion Compared with Macintosh laryngoscopy, Airtraq laryngoscopy achieved a better glotfic exposure view, increased the first time intubation probability of success, and released the haemodynamics changes, but lengthen the intubation time significantly.