超声引导与普通喉镜下气管插管的临床应用

Clinical study of endotracheal intubation with ultrasound-guided or normal laryngoscope

目的比较超声引导与普通喉镜下气管插管的临床应用,评估超声引导下实施气管插管的安全性及优缺点。方法选择择期全麻下手术的患者70例,ASAⅠ或Ⅱ级,性别不限,年龄20～60岁,体重46～78kg。随机分为超声引导组（U组,n=32）和普通喉镜组（L组,n=38）。插管前Mallampati法评估气道分级。U组采用超声引导法,在长轴和短轴显示会厌、声门和环状软骨后,经口插入套有气管导管的换管器,超声引导下将换管器置入声门,然后经换管器插入气管导管;L组采用普通喉镜暴露声门,直视下插入气管导管。以胸部听诊法及PETCO2监测综合判断气管插管是否成功,两次试插不成功被认定为插管失败,改用可视喉镜引导气管插管。记录气管插管成功率、误入食管例数、口咽部黏膜出血及轻度声门水肿发生率;记录插管前、插管后即刻及插管后5min的HR、SBP、DBP的变化。结果与L组比较,U组插管后即刻HR明显减慢,SBP和DBP明显降低（P〈0.05）;与插管前比较,两组插管后即刻HR明显增快,SBP和DBP明显升高（P〈0.05）。插管后5min,两组患者HR、SBP和DBP差异无统计学意义。两组患者气管插管成功率、误入食管、口咽黏膜出血和轻度声门水肿发生率差异无统计学意义。结论超声引导和普通喉镜下气管插管成功率无明显差异,但超声引导下气管插管可减少患者血流动力学波动和气管插管并发症。

Objective To compare the clinical effects of endotracheal intubation with ultrasound-guided or normal laryngoscope and evaluate the safety and efficiency of ultrasound-guided endo- tracheal intubation. Methods Seventy patients, with ASA Ⅰ or Ⅱ, aged 20-60 years, weighting 46- 78 kg for both genders, and scheduled from selective surgery under general anesthesia, were enrolled in this study and randomly divided into 2 groups： ultrasound-guided group （group U, n= 32） and normal laryngoscope group （group L, n=38）. Mallampati method was used to evaluate the airway classification of patients. Ultrasound-guided endotracheal intubation was performed in the group U. The epiglottis, glottis, and cricoid cartilage were shown by ultrasound, and then the guiding wire was inserted into the glottis through the mouth. The endotracheal tube was subsequently inserted into the trachea along the guiding wire. Normal laryngoscope-guided endotracheal tube was performed in the group L. The glottis was viewed directly by laryngoscope, and then the endotracheal tube was insert- ed into trachea. The right position of endotracheal tube was confirmed by chest auscultation and PE-rCO2 monitor. The failure intubation was defined as twice unsuccessful intubation and then the video laryngoscope was used to accomplish it. The success rate of endotracheal intubation, esophageal intubation cases, oropharyngeal bleeding cases, and incidence of mild glottis edema of each group were recorded. The alterations of HR, SBP, and DBP before intubation, immediately after intubation and 5 min after intubation were also recorded. Results Immediately after intubation, the HR, SBP, and DBP in the two groups were significantly increased, when compared with the pre-intubation （P〈 0. 05）. Compared with the group L, HR, SBP, and DBP in the group U were decreased immediately after intubation （P〈0. 05） and had no significant difference at 5 min after intubation. There had no significant difference in the success rate of endotracheal intubation, esophageal intubation, oropharynx bleeding and mild glottis between the two groups. Conclusion There was no significant difference in the success rate of endotracheal intubation with ultrasound-guided or normal laryngoscope, however, the ultrasound-guided endotracheal intubation reduces the hemodynamic response and complications from intubation of patients.