GlideScope喉镜与Macintosh喉镜辅助双腔气管导管插管术效果的比较

Comparison of GlideScope video-laryngoscope and Macintosh laryngoscope for double-lumen tube intuba- tion

目的比较GlideScope喉镜与Macintosh喉镜辅助双腔气管导管插管术的效果。方法选择胸科手术单肺通气的患者70例，ASA分级Ⅰ-Ⅲ级，年龄18-75岁，性别不限。采用随机数字表法，将患者分为2组（n=35）：GlideScope喉镜组（G组）和Macintosh喉镜组（M组）。麻醉诱导后，按照Cormack—Lehane分级评估Macintosh喉镜暴露声门程度。采用Macintosh喉镜（M组）和GlideScope喉镜（G组）辅助双腔气管导管插管术。记录Macintosh喉镜和GlideScope喉镜下Cormack—Lehane分级以及置入双腔气管导管的难易程度和双腔气管导管反向置管的发生情况；记录气管插管成功情况和气管插管时间。于气管插管前、气管插管后即刻和气管插管后3min记录血压及心率。记录术后相关不良反应的发生情况。结果与M组比较，G组气管插管时间延长，双腔气管导管置管困难程度升高，气管插管后即刻和气管插管后3min血压升高（P〈0．05），首次气管插管成功率、双腔气管导管反向置管率、Comark—Lehene分级和各时点心率差异无统计学意义（P〉0．05）；G组GlideScope喉镜下Cormack-Lehane分级优于Macintosh喉镜（P〈0．05）。结论与Macintosh喉镜相比，GlideScope喉镜辅助双腔气管导管插管术时能更好地暴露声门，改善气管插管条件，但方法较复杂，且插管反应较强。

Objective To compare the GlideScope video-laryngoscope and Macintosh laryngoscope for double-lumen tube （DLT） intubation. Methods Seventy ASA Ⅰ-Ⅲl patients, aged 18-75 yr, scheduled for tho- racic surgery and requiring one-lung ventilation, were randomly divided into 2 groups （ n = 35 each） ： Macintosh laryngoscope group （group M） and GlideScope video-laryngoscope group （group G）. Anesthesia was induced with propofol, fentanyl and rocuronium. The exposure of glottis obtained with Macintosh laryngoscope and GlideScope video-laryngoscope was assessed using Cormack-Lehane grade. DLT intubation was assisted with Macintosh laryn- goscope or GlideScope video-laryngoscope. The Cormack-Lehane grade, difficulty of DLT placement, and reverse DLT placement were recorded. The success rate of DLT placement at first attempt and intubation time were also recorded. Blood pressure and heart rate were recorded before intubation and at 0 and 3 min after intubation. The postoperative side effects were recorded. Results Compared with M group, the intubation time was significantly prolonged, the difficulty of DLT placement and blood pressure at 0 and 3 min after intubation were increased in G group （ P 〈 0.05）. There was no significant difference in the success rate of DLT placement at first attempt, rate of reverse DLT placement, Comark-Lehene grade and heart rate at each time point between the two groups （P 〉 0.05） . The Comark-Lehene grade obtained with GlideScope video-laryngoscope was superior to that obtained with Macintosh laryngoscope in G group （ P 〈 0.05）. Conclusion GlideScope video-laryngoscope can provide a better exposure of glottis and improvement in the intubating conditions, but the method is more complex and the responseto intubation is stronger than Macintosh laryngoscope for DLT intubation.