Airtraq可视喉镜和Macintosh喉镜在困难气管插管中的对比应用

Comparison of the Airtraq laryngoscopes and Macintosh laryngoscopes in patients with difficult tracheal intuba^ion

目的 探讨Airtraq可视喉镜和Macintosh喉镜在困难气管插管中的临床应用和对血流动力学的影响.方法 选择ASA Ⅰ～Ⅱ级,年龄20～62岁的Mallampatis Ⅲ~Ⅳ级的困难气道患者68例,随机均分为M组和A组.M组使用Macintosh喉镜传统方法直视下插管,A组使用Airtraq可视喉镜,全部患者采用相同的快速诱导方法进行气管插管,显露声门后在明视下气管插管;连续2次插管失败后采用Macintosh喉镜联合纤维支气管镜完成气管插管.从开口置入喉镜到气管插管成功并监测呼气末二氧化碳（ETCO2）确认插管正确无误为止进行秒表计时,记录完成气管插管的全部时间、插管次数、插管前后血流动力学变化、牙齿和口咽部有无损伤.结果 M组34例患者中16例一次插管成功,12例2次插管成功,另外6例经过两次插管失败后在Macintosh喉镜配合纤维支气管镜下插管成功;A组34患者中29例不需要导丝一次插管成功,另外5例声门显露清楚,但导管远端接近声门后联合而偏离声门中央,在特制的导丝引导下顺利完成插管.M组插管时间（82±38） s较A组（35±16） s显著延长（P＜0.01）;M组较A组插管开始0.5、1、3和5 min多个时点心率明显增快、血压显著升高（P＜0.05或P＜0.01）;M组插管后10例出现咽喉部少量渗血、2例门齿松动,A组1例咽喉部出血,无门齿损伤情况发生.结论 使用Airtraq可视喉镜在困难气管插管时具有快速、成功率高、应激反应小等优点,为困难气道处理提供了一种非常好的方法.

Objective To compare the use of the Airtraq laryngoscope versus Macintosh laryngoscope for difficult tracheal intubation. Methods Sixty - eight （ASA I - II , aged 20 - 62 years） patients with difficult tracheal intubation scheduled for elective operation were randomly divided into two groups. 34 patients with the traditional Macintosh laryngoscope （M group） and 34 patients were intubated with the Airtraq laryngoscope （A group）. ECG, non - invasive blood pressure （NIBP） , SpO2 and end - tidalcarbon dioxide （ ETCO2 ） were monitored. Before induction of anesthesia, all patients were given sufentanil （0.3 μg/kg） , propofol TCI （4 ~g/ml, blood plasma target level） , vecuronium bromide 0.03 mg/kg to produce loss of verbal response. All patients were administered with suxamethonium （2 mg/kg）. If tracheal intubation failed for two times with the Macintosh or Airtraq laryngoscopes, it should be combined Macintosh laryngoscopes with fiberoptic bronchoscope to complish tracheal intubation. The time of intubation, the number of unsuccessful intubation attempts, changes of haemodynamics, complications （luring and after laryngoscopy and intubation were documented and compared between the groups. Results In the Macintosh laryngoscope group, 16 patients＇ tracheal intubation were successfully carried out in one time, 12 patients were successfully carried out in two times, 6 patients failed and required combining Macintosh laryngoscopes with fiberoptic bronchoscope to eomplish tracheal intubation. Intubation with the Airtraq laryngoscope was quicker （35 ± 16） s than with the Macintosh laryngoscope （ 82 ± 38 ） s （ P 〈 0.01 ）. The changes of blood pressure and heart rate were less in Airtraq group than in Macintosh group （ P 〈 0.01 ）. Conclusions The Airtraq laryngoscope can raise achievement ratio,shorten the duration of trachealintubation, reduce stress reactionand and prevent some complications in difficult airway patients.