视可尼可视喉镜在冠状动脉性心脏病患者气管插管中的应用

Clinical application of Shikani optical stylet in endotracheal intubation in patients with coronary heart disease

目的比较视可尼可视喉镜(SOS)与普通直接喉镜应用于冠状动脉性心脏病患者气管插管时血流动力学的变化。方法选择美国麻醉医师协会分级Ⅱ或Ⅲ级,于全身麻醉下行手术的冠状动脉性心脏病患者40例,随机分入SOS组和普通直接喉镜组(对照组),每组20例。所有患者均依次静脉注射利多卡因1mg/kg、咪达唑仑0.05mg/kg、芬太尼3μg/kg、丙泊酚1μg/mL、罗库溴铵0.6mg/kg行麻醉诱导。在麻醉前(T_0)、麻醉诱导后(T_1)、暴露声门时(T_2),以及插管后1min(T_3)、5min(T_4)各时间点,记录并比较两组患者的收缩压(SBP)、舒张压(DBP)、心率(HR)、心率收缩压乘积(RPP)和脑电双频指数(BIS)值。结果两组患者T_1时间点的SBP、DBP和RPP均显著低于同组T_0时间点(P值分别<0.05、0.01),T_2、T_3、T_4时间点的SBP、DBP、HR和RPP均显著高于同组T_1时间点(P值分别<0.05、0.01)。SOS组T_2、T_3时间点的SBP、HR、RPP和T_2时间点的DBP均显著低于对照组同时间点(P值分别<0.05、0.01)。结论相比于普通直接喉镜,气管插管时应用SOS能有效地减少冠状动脉性心脏病患者的血流动力学波动。

Objective To compare the hemodynamic responses of using Shikani optical stylets and direct laryngoscopes in endotracheal intubation for patients with coronary heart disease. Methods Forty patients with coronary heart disease, American Society Anesthesiologist （ASA） physical status Ⅱ or Ⅲ, scheduled for surgery under general anesthesia were randomly divided into two groups （n = 20）： Shikani optical stylet group （Shikani group） and direct laryngoscope group （control group）. The induction of anesthesia was performed in all the patients by successive intravenous injection of lidocaine 1 mg/kg, midazolam 0. 05 mg/kg, fentanyl 3 μg/kg, propofol 1 μg/mL and rocuronium 0.6 mg/kg. The systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR）, rate-pressure product （RPP） and bispectral index（BIS） were recorded before anesthesia （T0）, after induction of anesthesia （T1）, at endoscopic laryngeal intubation （T2）, 1 min after intubation （T3） and 5 min after intubation （T4）. Results The SBP, DBP and RPP at T1 were significantly lower than those at To in both groups （ P〈0.05, 0.01 ）. The SBP, DBP, HR and RPP at T2, T3 and T4 were significantly higher than those at T1 in both groups （P〈0.05, 0.01）. The SBP, HR and RPP at T2 and T3, the DBP at T2 in the Shikani group were significantly lower than those in the control group at the same time （ P〈0. 05, 0.01 ）. Conclusion Compared with direct laryngoscopes, Shikani optical stylet can effectively reduce hemodynamic changes caused by tracheal intubation in patients with coronary heart disease.