Airtraq可视喉镜及普通喉镜气管插管对慢性阻塞性肺疾病合并呼吸衰竭患者应激反应及血流动力学影响的对比研究

Comparison of Impact on Stress Reaction and Haemodynamics of COPD Patients Complicated with Respiratory Failure between Airtraq Visual Laryngoscope and Normal Laryngoscope Tracheal Intubation

目的比较Airtraq可视喉镜及普通喉镜气管插管对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者应激反应和血流动力学的影响。方法选取2013年12月—2014年12月暨南大学第五附属医院(清远市人民医院)急诊科收治的需行紧急气管插管的COPD合并呼吸衰竭患者60例,按随机数字表法分为对照组和观察组,每组30例。观察组患者采用Airtraq可视喉镜气管插管,对照组患者采用普通喉镜气管插管。比较两组患者声门暴露情况、气管插管时间及插管次数,气管插管前(T0)、气管插管后即刻(T1)、气管插管后3 min(T2)血清去甲肾上腺素(NE)和肾上腺素(E)水平,血流动力学指标〔心率(HR)、平均动脉压(MAP)及心率与收缩压乘积(RPP)〕。结果观察组患者声门有效暴露率为96.0%,高于对照组的68.0%(P<0.05)。观察组患者气管插管时间短于对照组,插管次数少于对照组(P<0.05)。T0时两组患者血清NE、E水平比较,差异无统计学意义(P>0.05);T1及T2时观察组患者血清NE、E水平低于对照组(P<0.05)。T0时两组患者HR、MAP、RPP比较,差异无统计学意义(P>0.05);T1及T2时观察组患者HR、MAP、RPP均低于对照组(P<0.05)。结论在COPD合并呼吸衰竭患者气管插管中,Airtraq可视喉镜较普通喉镜气管插管的声门有效暴露率高,机体应激反应轻,血流动力学波动小。

Objective To compare the impact on stress reaction and haemodynamics of COPD patients complicated with respiratory failure between Airtraq visual laryngoscope and normal laryngoscope tracheal intubation. Methods From December2013 to December 2014, a total of 60 COPD patients complicated with respiratory failure were selected in the Department of Emergency, the Fifth Affiliated Hospital of Ji＇nan University （People＇s Hospital of Qingyuan）, and they were divided into control group and observation group according to random number table, each of 30 eases. Patients of control group were treated by normal laryngoscope tracheal intubation, while patients of observation group were treated by Airtraq visual laryngoscope tracheal intubation. The effective glottis exposure rate, intubation time and intubation times, serum norepinephrine and epinephrine levels, hemedynamic index （including HR, MAP and HR x SBP） before intubation, immediately after intubation, 3 minutes after intubation were compared between the two groups. Results The effective glottis exposure rate of observation group was 96. 0%, was statistically significantly higher than that of control group of 68.0% （ P 〈 0. 05 ）. The intubation time of observation group was statistically significantly shorter than that of controlgroup, and the intubation times of observation group was statistically significantly less than that of control group （ P 〈0. 05 ）. No statistically significant differences of serum norepinephrine or epinephrine level, HR, MAP or HR x SBP was found between the two groups before intubation （ P 〉 0. 05）, while above index of observation group were statistically significantly lower than those of control group （ P 〈0. 05 ）. Conclusion Airtraq visual laryngoscope tracheal intubation has significantly higher effective glottis exposure rate than normal laryngoscope tracheal intubation in COPD complicated with respiratory failure, with mild stress reaction and hemodynamic fluctuations.