GlideScope视频喉镜和Macintosh直接喉镜用于鼾症患者气管插管的比较

Comparison the applications of tracheal intubation with GlideScope video laryngoscope and Macintosh direct laryngoscope in snoring patients

目的:比较GlideScope视频喉镜(GSVL)、Macintosh直接喉镜(MDLS)2种插管设备对鼾症患者全身麻醉诱导后气管插管的有效性和安全性。方法:40例美国麻醉医师协会Ⅰ～Ⅲ级择期行鼾症手术的患者,随机分为GSVL组和MDLS组(每组各20例)。常规麻醉诱导后,分别采用GSVL、MDLS经口气管插管,记录2组声门显露情况、气管插管时间(面罩通气结束至气管插管成功即刻的时间)、气管插管操作的次数;记录麻醉诱导前(基础值T0)、气管插管前即刻(T1)、气管插管后即刻(T2)、气管插管后1min(T3)、气管插管后3min(T4)平均动脉压(MAP)及HR的变化。结果:声门显露情况GSVL组优于MDLS组;气管插管时间MDLS组为(27±11)s,GSVL组为(26±11)s,差异无统计学意义;与T0相比,2组患者T1的MAP降低(P<0.05),HR差异无统计学意义(P>0.05);T2、T3的MAP增高、HR增快(P<0.05);T4的MAP下降,但HR仍增快(P<0.05);组间比较各时点MAP、HR差异无统计学意义(P>0.05)。结论:GSVL与MDLS相比,有利于改善鼾症患者气管插管时的声门显露,从而提高气管插管的成功率;但GSVL在预防气管插管时的血液动力学反应方面并无明显优势。

Objective： To compare the efficacy and safety of applications of GlideScope video laryngoscope （GSVL） and Macintosh direct laryngoscope（MDLS） during endotracheal intubation under general anesthesia of abdominalsnoring surgeries. Method： Forty patients ranged from American Society of Anesthesiologists I to HI scheduled for snoring surgery under general anesthesia with endotracheal intubation were randomly divided into GSVL group and MDLS group （20 cases in each group）, After traditional induction, endotracheal intubation （ETT） performed by GSVL or MDLS. Glottic exposure, the time of endotracheal intubation（from mask ventila- tion ending to successful intubation） ,the times of tracheal intubation operation were recorded in both groups. The mean artery pressure（MAP）, heart rate（HR） were monitored before induction（basic value T0）, before tracheal in- tubation（T1）,after tracheal intubation（T2）, lmin after tracheal intubation（T3）, 3mins after tracheal intubation （T4）. Result：The glottic exposure of GSVL group is superior to that of MDLS group. There was no significant difference in the time of tracheal intubation between MDLS group （27 ± 11）s and GSVL group（26 ± 11 ）s （P〈0.05）. Compared with T0,MAP of T1 was lower in two groups （P〈0.05） ,while HR were similar both in two groups（P〈0.05）. MAP of T2 and T3 increased and HR became faster（P〈0.05）. MAP of T4 declined, but HR still increased（P〈0.05）. Between the two groups, there was no significant difference of MAP or HR （P〉 0.05）. Conclusion：Comparied with MDLS,the GSVL is of benefit to improve the glottic exposure in endotracheal intubation to the snoring patients, so as to improve the success rate of tracheal intubation. But there is no obvious advantages via GSVL in preventing hemodynamic reaction during tracheal intubation.