HC视频喉镜在全身麻醉手术儿童气管插管中的应用效果

Application of HC video laryngoscope in endotracheal intubation in children after general anesthesia

目的比较患儿HC视频喉镜与Macintosh直接喉镜引导气管插管术的效果。方法选取2012年-2014年全身麻醉手术患儿80例,ASA分级为I或Ⅱ级,Mallampati分级I或Ⅱ级,年龄1～7岁,男女不限,采用随机数表法将80例患儿分为HC视频喉镜组（H1组）和Macintosh直接喉镜组（M1组）,每组各40例。30例可能存在困难气道的全身麻醉手术患儿,ASA分级为I或Ⅱ级,Mallampati分级Ⅲ或Ⅳ级,年龄2～6岁,男女不限,采用随机数表法分为两组：HC视频喉镜组（H2组）和Macintosh直接喉镜组（M2组）,每组各15例。对患儿施行全身麻醉后,H1组和H2组采用HC视频喉镜法引导气管插管,M1组和M2组采用Macintosh直接喉镜法引导气管插管。声门显露程度用Cormark—Lehane分级法评价,还需如实记录气管插管时间、H2组和M2组气管插管成功时的张口度、气管插管成功情况;记录气管插管过程中牙齿、口唇、牙龈及咽喉部软组织损伤的例数及程度和术后24 h发生声音嘶哑的例数。结果 H1组与M1组在气管插管时间、声门显露程度和首次气管插管成功率上的差异无统计学意义（P〉0.05）。气管插管过程中牙齿、口唇、牙龈、咽喉部软组织损伤和术后24 h声音嘶哑的例数,H1组比M1少,两组差异具有统计学意义（P〈0.05）。与H2组比较,M2组气管插管时间延长,首次气管插管成功率降低,气管插管成功时张口度增大,声门显露程度增加,气管插管过程中口唇、牙齿、牙龈、软组织损伤和术后声音嘶哑的发生率增加,两组差异具有统计学意义（P〈0.05）。结论与Macintosh直接喉镜引导气管插管术相比,HC视频喉镜引导气管插管术操作简单便捷,成功率高,并发症少,刺激小,可优先考虑用于困难气道患儿。

【Objective】 To compare the effect of HC video laryngoscope or Macintosh direct laryngoscope in guiding endotracheal intubation in children.【Methods】From 2012 to 2014, 80 cases of children undergoing general anesthesia, with ASA grade I or grade Ⅱ, Mallampati grade I or grade Ⅱ, aged 1-7 years old, male or female,were divided into HC video laryngoscope group（H1 group） and Macintosh direct laryngoscope group（M1 group） using a random number table method, with 40 cases in each group. Thirty children undergoing general anesthesia probably with difficult airway, ASA classification of I or Ⅱ, Mallampati grade Ⅲ or grade Ⅳ, aged 2～6 years old,male or female, were divided into two groups, HC video laryngoscope group（H2 group） and Macintosh direct laryngoscope group（M2 group） using a random number table, with 15 cases in each group. After the implementation of general anesthesia in children, HC video laryngoscope-guided intubation was performed in H1 and H2 group, Macintosh direct laryngoscope-guided intubation was performed in M1 and M2 group. Cormark-Lehane grading method was used to evaluate the degree of glottis exposure, the intubation time, the mouth opening of successful intubation and intubation success cases in H2 and M2 groups need to be faithfully recorded; the number of cases and the extent of soft tissue injury of teeth, lips, gums and throat during intubation, the number of cases of hoarseness 24 h after surgery were recorded. 【Results】The differences in the intubation time, the degree of glottis exposure and the first intubation success rate between H1 group and M1 group was not statistically significant（P 〉0.05）. The number of cases of soft tissue injuries of teeth, lips, gums, throat during intubation and the number of cases of hoarseness 24 h after surgery in H1 group were less than those in M1 group, and the difference was statistically significant（P〈 0.05）. Compared with H2 group, intubation time was prolonged, intubation success rate at the first attempt decreased,mouth opening was wider when the intubation was successful, the degree of glottis exposure was increased, the incidence of soft tissue injuries of the lips, teeth, gums during intubation and the incidence of postoperative hoarseness increased in M2 group, and the difference between the two groups was statistically significant（P 〈0.05）.【Conclusion】Compared with Macintosh direct laryngoscope-guided endotracheal intubation, HC video laryngoscope-guided endotracheal intubation is simple and convenient with high success rate, fewer complications, little stimulation, and it can be prioritized for children with difficult airways.