光杖联合直接喉镜应用于老年患者气管插管的临床分析

Application of Light Wand Joint Direct Laryngoscopy in the Intubation of Elderly Patients

目的:研究光杖联合直接喉镜对老年手术患者气管插管全麻诱导下的血流动力学与气道并发症的影响。方法:选择45例ASAⅠ-Ⅲ级拟行全麻手术的老年患者,男23例,女22例,年龄65-82岁,随机分成光杖组(A组)、直接喉镜组(B组)和光杖联合直接喉镜组(C组)。三组患者采用相同的全身麻醉诱导方法,分别记录麻醉诱导前(T0)、麻醉诱导后(T1)、插管即刻(T2)和插管后1min(T3)的收缩压(SBP)、舒张压(DBP)、心率(HR)和氧饱和度(SpO2)。记录插管时间和插管成功的例数,并观察并发症。结果:插管即刻(T2)HR、SBP、DBP、SpO2在B组与C组之间差异有统计学意义(P<0.05),插管后1min HR、SBP、DBP、SpO2在B组与C组之间差异有统计学意义(P<0.05),C组并发症少于A、B组,插管时间C组短于A、B组(P<0.05)。结论:在老年患者中光杖联合直接喉镜气管插管,成功率高,可以有效减轻气管插管的应激反应,对老年患者血流动力学影响较小。

Objective： To study hemodynamic changes and injuries to oral cavity and throat during oral tracheal intubation with light wand joint direct laryngoscopy in elderly patients. Methods： Forty- five patients （ASA I -Ⅲ , 23 males and 22 females, aged 65-82 years） scheduled for surgery un- derwent general anesthesia with oral tracheal intubation9 were randomly divided into three groups： A （light wand group）, B （direct laryngoscopy group）, and C （light wand combined with direct laryngoscopy group）. General anesthesia in the three groups was induced with the same methods. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, and pulse oxygen saturation degree （SpOz） were recorded at four time points： before anesthesia in- duction （T0）, after anesthesia induction （T1）, immediately after intubation （T2）, and 1 minute after intubation （T3）. The intuhation time and successful cases with incubation were recorded. The postoperative complications were observed after incubation. Results. HR, SBP, DBP, and SpO2 difference between group B and group C at T2 and Ts points were significantly different （P 〈0.05）. Compared with that in groups A and B, the incidence of postoperative complications was significantly decreased in group C. The time of intubation in group C was less than in groups A and B. Conclusion. Oral tracheal intubation with light wand joint direct laryngoscopy in elderly patients can increase the successful cases with incubation, effectively reduce the stress response of intubation, and has less impact on the hemodynamic changes.