Shikani与Macintosh两种喉镜在胸科手术患者双腔支气管插管中的比较

Comparison of the shikani optical stylet iaryngoscope and macintosh direct laryngoscopes for placement of double-lumen endobranchial tube

目的:比较Shikani喉镜和Macintosh喉镜,在胸科手术患者双腔支气管插管的临床效果。方法:选择需行单肺通气的胸外科手术患者60例,随机均分为两组,Shikani喉镜组(S组)和Macintosh喉镜组(M组)各30例。麻醉诱导后分别采用Shikani喉镜或Macintosh喉镜,实施经口双腔支气管插管操作。记录并比较麻醉诱导前(T1)、气管插管前(T2)、气管插管后即刻(T3)、气管插管后5 min(T4)的平均动脉压(MAP)值、心率(HR)值和脑电双频指数(BIS)值。观察比较2组插管时间、置入目标支气管的成功率及口腔损伤出血情况。结果:在T3点,M组患者的平均动脉压(MAP)和心率(HR)均明显高于S组患者(P<0.05),其余各时间点两组患者的血流动力学指标,差异均无统计学意义。各点脑电双频指数(BIS)值,两组间比较差异均无统计学意义。S组患者的插管时间明显<M组(P<0.05)。进入目标支气管的成功率和口腔损伤出血情况,两组间比较差异均无统计学意义。结论:与Macintosh喉镜相比,在胸科手术患者双腔支气管插管操作过程中,使用Shikani喉镜插管对血流动力学影响更小,且插管时间更短。

Objective：To compare the clinical application of shikani optical stylet（SOS） laryngoscope and macintosh direct laryngoscope（MDLS） for the placement of double-lumen endobranchial tube（DLT） during anesthesia induction in thoracic surgery.Methods：A total of 60 patients scheduled for thoracic surgery requiring one-lung ventilation were divided randomly into 2 groups（Group S and Group M） with 30 cases each.The patients in group S were intubated with SOS laryngoscope while the patients in group M were intubated with MDLS.The value of MAP,HR,SpO2 and BIS was recorded and the comparison was done between the 2 groups at following time points： the beginning of anesthetic induction（T1）and intubation（T2）,immediate point after intubation（T3） and 5min（T4） after infusion.The intubation time,the number of DLT malposition after intubation and the injuries of lip,dentition or tongue were documented and compared between the 2 groups.Results：MAP and HR immediately after intubation were significantly higher in group M than in group S（P〈0.05）.The intubation time was shorter in group M than in group S（P〈0.05）.Conclusion：The hemodynamic responses at the immediate point after intubation is milder in SOS laryngoscope than in MDLS.SOS laryngoscope can reduce the intubation time for placement of double-lumen endobranchial tube comparing to MDLS.