Glidescope视频喉镜在模拟颈椎活动受限病人气管插管中的应用

The practice of glidescope in patients with simulated cervical spine immobilization

目的比较Glidescope视频喉镜和直接喉镜(Macintosh)在使用Ambu颈托固定模拟颈椎活动受限病人气管插管中的应用。方法选取拟行择期手术需全身麻醉气管插管的80例患者,随机分为Glidescope(G组,n=40)和Macintosh组(M组,n=40)。麻醉诱导后,使用Ambu颈托固定颈椎,由熟练掌握该两种工具的同一麻醉医师完成气管插管,记录各组成功插管所需要的时间、声门暴露时间、声门暴露分级(Cormack-Lehane分级)、一次插管成功率、总插管成功率、辅助措施次数等。同时记录诱导前(T0)、插管前30 s(T1)、插管后1 min(T2)、插管后2 min(T3)、插管后3min(T4)、插管后5 min(T5)的平均动脉压(MAP)和心率(HR)。结果完成插管所需时间:G组为53.78±7.84 s,M组为42.48±8.32 s,G组明显长于M组(P<0.05);一次插管成功率:G组和M组分别为77.5%和97.5%,G组明显低于M组(P<0.05);但两组间的总插管成功率比较,差异无统计学意义(90.00%vs.97.5%,P>0.05);C-L分级:G组的C-L分级优于M组(P<0.05)。两组气管插管期间血流动力学波动及并发症发生情况无显著差异(P>0.05)。结论用于Ambu颈托固定模拟颈椎活动受限病人气管插管,Glidescope视频喉镜可改善该类病人的C-L分级,但一次插管成功率及完成插管时间与Macintosh喉镜比较无优势。

Objective To compare the clinical application of the Macintosh and Glidescope in intubation for the patients with simulated neck immobilization using Ambu rigid collar. Methods 80 patients undergoing general anesthesia who required tracheal intubation were randomly assigned to two groups：Glidescope（G group,n = 40）and Macintosh（M group,n = 40）. After induction of anesthesia,the neck of the patients was immobilized with Ambu rigid collar. And the tracheal intubation was performed by an experienced anesthetist who was familiar with each of these two devices. The duration of the successful attempt was recorded. The success rate for intubation in the first attempt and the overall success rate for intubation were recorded too. The duration of visualized glottis,the Cormack - Lehane classification and the number of optimization maneuvers required to aid tracheal intubation,the hemodynamic data（MAP and HR of the T0 ,T1 ,T2 ,T3 ,T4 and T5 ）were also recorded and analyzed. Results The duration of the successful tracheal intubation attempts was 53. 78 ± 7. 84 s（G）and 42. 48 ± 8. 32 s（M）,respectively, there were significant difference between two groups（ P 〈 0. 05）. The rate of the first successful tracheal intubation in M group（97. 5% ）was significantly higher than G group（77. 5% ）（ P 〈 0. 05）. The Cormack - Lehane classification of G group was significantly better than M group（ P 〈 0. 05）. Conclusion Compared with the Macintosh,the Glidescope showed no effectiveness in the success rate for intubation in the first attempt and the duration of the successful tracheal intubation attempts in the intubation for the patients when neck was immobilized using Ambu rigid collar. However,this method can improve the Cormack - Lehane classification.