可视喉镜在侧卧位插管中的应用

背景侧卧位时，应用喉镜暴露咽喉部难以达到满意的效果，给气管插管造成一定难度。可视喉镜的应用克服了这一困难，即便喉镜暴露不佳（多发生在侧卧位时），也能比较顺利地完成气管插管。本文中，我们比较了可视喉镜应用于仰卧位及左／右侧卧位时气管插管的效果。方法麻醉后的成年患者随机分为3组，每组43例：仰卧位组、左侧卧位组及右侧卧位组。每组患者先用Macintosh喉镜暴露咽喉部，继之以可视喉镜行气管插管。我们特别对如下假说进行验证：与仰卧位气管插管比较，侧卧位气管插管所需时间延长不会超过10秒。结果总体插管成功率，侧卧位为100％，仰卧位为98％。各组插管时间接近，左侧卧位为24±5秒，右侧卧位为24±6秒，仰卧位为22±7秒。尝试插管次数在左侧卧位及右侧卧位之间、仰卧位及左侧卧位之间是相近的。而仰卧位的插管次数多于右侧卧位，且差异有统计学意义（P=0．004）。各组气管插管并发症的发生率基本一致；未发现低氧血症、牙齿损伤或误入食管现象。左侧卧位及右侧卧位时，改良的Cormack．Lehane及POGO评分在组间比较无显著性差异。但仰卧位时，上述两项指标显著优于侧卧位（P〈0.001）。结论虽然侧卧位时的喉镜显露效果差于仰卧位，但是可视喉镜的应用提高了气管插管成功率。而且，与仰卧位相比，侧卧位时可视喉镜插管时间延长并未超过10秒。因此，当患者需要行侧卧位气管插管时，可视喉镜有望成为一种有效的工具。

BACKGROUND： Tracheal intubation in the lateral position is difficult because the laryngeal view is compromised during direct laryngoscopy. The Airway Scope facilitates intubation even when laryngeal views are poor with direct laryngoscopy, as they often are in the lateral position. We thus compared the efficacy of the Airway Scope in supine patients with those in the left- and right-lateral positions. METHODS： Anesthetized adults were randomly assigned to supine, left-lateral, or right-lateral position （n --43 for each group）. Laryngeal views were obtained in the designated position with a Macintosh laryngoscope, and patients＇ tracheas were subsequently intubated with the Airway Scope. Specifically, we tested the hypothesis that the time required for intubation in the left- and right-lateral positions is not increased by 〉10 seconds compared with tracheal intubation in the supine position. RESULTS： Overall intubation sucoess was 100% in the 2 lateral positions, and 98% in the supine position. Intubation times were similar in the left-lateral （24 ~5 ~ seconds, mean [ SD] ）, right-lateral （24 [ 6 ] seconds）, and supine （22 ~ 7 J seconds） positions. The numbers of required intubation attempts were similar in the 2 lateral positions and in the supine and left-lateral positions. However, more intubation attempts were required in the supine position than in the right-lateral position （P = 0. 004）. The incidences of airway complications were similar in each position; no hypoxia, dental injury, or esophageal intubation was observed. Modified Cormack-Lehane and the percentage of glottic opening scores obtained with the Macintosh laryngoscope did not differ between the 2 lateral positions, but the modified Cormack-Lehane and percentage of glottic opening scores were superior in the supine position （all P 〈 0.001 ） compared with either of the lateral positions. CONCLUSIONS： Despite worse laryngoscopic views in either lateral position than when patients were supine, intubation with the Airway Scope offered high success rates. Furthermore, intubation time using the Airway Scope in either lateral position was not longer by 〉10 seconds than in the supine position. The Airway Scope thus seems to be a useful tool when tracheal intubation is required in a laterally positioned patient.