GlideScope视频喉镜在预见困难气管插管中的应用效果

Application of Glide Scope video laryngoscope in patients with foreseen difficulties in tracheal intubation

目的 比较全身麻醉下GlideScope视频喉镜和普通Macintosh直接喉镜进行气管插管的效果.方法 选择改良Mallampati评级达到Ⅲ级或Ⅳ级经口气管插管全麻患者100例,年龄18-60岁.按随机数表法分为GlideScope视频喉镜组（G组）和普通Macintosh直接喉镜组（M组）,每组50例.记录患者改良Mallampati评级、Cormack-lehane分级（C/L分级）、声门暴露时间、气管插管时间、诱导前后平均动脉压（MAP）、心率（HR）和插管相关并发症.结果 与M组比较,G组声门最佳显露时C/L评级明显低（C/L评级Ⅰ/Ⅱ/ⅢG组和M组分别为15/14/1和1/25/24,t=10.999,P=0.000）和气管导管置入时间明显缩短[G组和M组分别为（17.6 ± 8.2） s和（30.8 ± 10.7） s,t=3.491,P=0.000];与M组比较,G组一次插管成功率、声门暴露时间、插管后1 min的MAP和HR变化和插管相关并发症比较差异均无统计学意义（P〈0.05）.结论 以改良Mallampati评级Ⅲ或Ⅳ级作为预见插管困难患者中,全身麻醉下GlideScope视频喉镜比Macintosh直接喉镜明显提高声门显露质量和缩短插管时间;而两者均有很高的第一次插管成功率,声门显露时间、插管前后心血管反应和相关插管并发症相似.

Objective To compare the effect of GlideScope video laryngoscope and Macintosh direct laryn-goscope intubation for tracheal intubation under general anesthesia. Methods One hundred patients of modified Mal-lampati gradeⅢorⅣfor tracheal intubation under general anesthesia, aged 18 to 60 years old, were randomly divid-ed into GlideScope video laryngoscope group （group G） and Macintosh direct laryngoscope group （group M）, with 50 cases in each group. Modified Mallampati grade, Cormack-lehane grade （C/L grade）, glottis exposure time, intubation time, mean artery pressure （MAP） and heart rate （HR） before and after induction, as well as intubation-related compli-cations were recorded. Results Compared with group M, C/L grade in group G was significantly lower （C/L gradeⅠ/Ⅱ/Ⅲwere 15/14/1 in group G and 1/25/24 in group M, t=10.999, P=0.000）, and the endotracheal tube placement was significantly shorter [（17.6±8.2） s in group G vs （30.8±10.7） s in group M, t=3.491, P=0.000]. Compared with group M, success rate of first intubation, glottis exposure time, MAP and HR changes 1 min after intubation and intuba-tion-related complications in group G showed no statistically significant difference （P〈0.05）. Conclusion In patients of modified Mallampati grade Ⅲ or Ⅳ with difficulties in tracheal intubation under general anesthesia, GlideScope video laryngoscope results in significantly improved glottis exposure quality and shortened intubation time, compared with Macintosh direct laryngoscope. However, the two methods both have high success rate of first intubation, with similar glottis exposure time, cardiovascular response after intubation and intubation-related complications.