可视电子气管导管对老年全麻患者潜在困难气道插管的可行性研究

Feasibility study of visual endotracheal intubation in elderly patients with a potentially difficult airway under general anesthesia

目的评估ETView可视电子气管导管应用于老年全麻患者潜在困难气道插管的可行性。方法拟择期行全麻手术气管插管的老年患者80例，年龄65～86岁，随机分为普通气管导管组（C组）和ETView可视电子气管导管组（E组），每组40例。两组患者在常规麻醉诱导的基础上，c组患者使用普通气管导管，E组使用ETView可视气管导管插管，记录两组患者麻醉诱导前（T。）、首次气管插管前（T。）、气管插管成功即刻（Tz）、气管插管成功后5min（T3）心率和血压的变化，以及两组患者的插管时间、尝试插管次数、1次插管成功率、插管前后血流动力学变化以及术后2d内气管插管并发症的发生率。结果E组患者平均插管时间（34±6）S、尝试插管次数（1．0±0．0）次，明显少于C组（48±22）S、（1．4±0．4）次（t=2．484、2．373，P=0．017、0．023）；E组患者1次插管成功率为100％（40例），明显高于C组1次插管成功率75％（30例）（χ2=5．714，P=0．017）；两组患者插管过程中血流动力学指标、术后2d内声音嘶哑发生率比较，差异无统计学意义（P〉0．05）。结论ETView可视电子气管导管可安全用于全麻潜在困难插管的老年患者，有助于缩短插管时间，提高患者1次插管成功率。

Objective To evaluate the feasibility of ETView visual endotracheal intubation in elderly patients with a potentially difficult airway under general anesthesia. Methods A total of 80 patients scheduled for elective surgery, with at least three characteristics indicative of an increased risk for difficult tracheal intubation and aged 65-86 years with American Society of Anesthesiologists （ASA） grade Ⅱ or Ⅲ, were selected and randomly assigned into 2 groups： the control group （Group C） and the ETView visual endotracheal intubation group （Group E） （n=40 for each）. After induction with propofol 0.5-1.5 mg/kg, sufentanil 0.2ug/kg, and rocuronium 0.6mg/kg, regular tracheal intubation and ETView visual endotracheal intubation were conducted in Group C and Group E respectively. Blood pressure and heart rate were recorded before induction （T0）, before initial intubation （T1）, at successful intubation （T2）, and 5rain after successful intubation （T3）. Duration of catheterization, number of intubation attempts, rate of successful intubation at first attempt and complications within 2 days of intubation were also recorded. Results The duration of catheterization and the number of intubation attempts were lower in Group E than in Group C^（34!-6） s w （48=t= 22） s, （1.0!-0.0） w （1.4~＋0.4）, t=2.484 and 2.373, respectively, P=0.017 and 0. 023, respectively3. The rate of successful intubation at first attempt was higher in Group E than in Group C （100% or 40 cases vs. 75G or 30 cases）, Z2 =5. 714, P=0. 017）. There was no significant difference in hemodynamic changes and the rate of postoperative hoarseness between the two groups （P〉0.05 for both）. Conclusions ETView visual endotracheal intubation shows excellent safety in elderly patients with a difficult airway under general anesthesia, with shorter catheterization duration and a higher rate of successful intubation at first attempt than regular intubation.