Macintosh喉镜片辅助下不同头位经口明视插管的效果比较

Effect of Different Head Position in Endotracheal Intubation Assisted with Macintosh Laryngoscope

【目的】研究在Macintosh喉镜片辅助下进行经口明视气管插管时应用简单头后仰或修正式喉镜头位的插管难易程度和对咽喉部刺激方面的差异。【方法】选取本院年龄15～72岁，ASAI～Ⅱ级，进行择期非咽喉手术气管插管全麻患者864例，随机将其分为使用简单头后仰位插管组（S组）和修正式喉镜头位插管组（C组），记录比较在同一经过正规培训的麻醉医师应用相同规格的Macintosh喉镜，应用简单头后仰位和修正式喉镜头位暴露声门的CormackandLehane分级情况和成功插管所需的时间。【结果】①S组成功插管所需的时间较C组时间短，且两组相比较差异有显著性（P〈0．05）；②S组在暴露声门的CormackandLe—hane分级比C组高，且差畀有显著性（P＜0．05）；③术后d1咽喉镜检查中，s组咽部损伤的位置集中在会厌舌面且程度较重，C组咽部损伤的位置集中在颚咽弓处且程度较轻；④S组咽部出血和牙齿脱落并发症发生率高于C组（PdO．05）；两组均未发生脊髓损伤后遗症。【结论】在Macintosh喉镜片辅助下进行经口明视气管插管时应用简单头后仰头位较修正式喉镜头住所需插管时间较短，但咽部刺激和并发症的发生率较高。

[Objective] To discuss the difference of the pharyngeal stimulation at endotracheal intubation assisted with the Macintosh laryngoscope through a simple head hypsokinesis , or modifying the position of la- ryngeal lens,.[Methods]864 patients aged between 15-72 at ASA I -Ⅱ were chosen, who would take endo- tracheal intubation under general anesthetic and have nonlaryngeal operation. Patients were randomly divided into the head back group （group S） and the laryngeal lens modification group（ group C）. The C0rmack and Lehane glottal exposure classification and successful intubation time were recorded and compared, which performed by formally trained anesthesiologists who used the same specifications of the Macintosh laryngoscope with a simple head hypsokinesis or modification of laryngoscope lens.[ Results]1 .The time of successful intubation in group S was shorter than that in group C, and the difference between the two groups was significant （ P 〈0.05） 2. The Cormack and Lehane level in group S is higher than that in group C , and the difference was significant （ P 〈0.05） ; 3. In the next day＇s pharyngoscope testing, the pharyngeal injuries in group S were serious and mainly concentrated in the lingual surface of epiglottis , while those in group C were mild and mainly concentrated in pharyngeal arch ; 4. The incidence of pharyngeal hemorrhage and tooth loss in the group S were higher than those in group C （ P〈0.05） ; The two groups had no sequelae of spinal cord injury. [Conclusion] With the assistance of the Macintosh laryngoscope, a simple head hypsokinesis at endotracheal intubation takes less time than laryngeal lens modification, but pharyngeal stimulation is heavier and the incidence of complications are higher.