光棒引导与直接喉镜在食管裂孔疝手术患者气管插管麻醉中的应用比较

Compared with lightwand and direct laryngoscope used in tracheal intubation in hiatal hernia operation

目的比较光棒和直接喉镜在食管裂孔疝手术患者气管插管麻醉中的应用效果。方法选择美国麻醉师协会（ASA）分级Ⅰ~Ⅱ级,拟在全身麻醉插管下行食管裂孔疝手术的患者60例,随机数字法分为光棒组（L组）和直接喉镜组（M组）。观察并记录两组患者一次插管成功率、插管时间、麻醉诱导前（T0）、插管即刻（T1）、插管后1 min（T2）、插管后3 min（T3）、插管后5 min（T4）的收缩压（SBP）、舒张压（DBP）、心率（HR）,观察插管后有无口腔黏膜、牙齿牙龈损伤等的发生,术后24 h内随访有无咽喉疼痛和声音嘶哑等不良反应。结果 L组一次插管成功率96.7%（29/30）,M组93.3%（28/30）;L组插管时间（13.5±6.1）s,M组插管时间（29.3±11.2）s,差异有统计学意义（P〈0.05）。L组在T1、T2、T3时间点的SBP、DBP和HR无明显变化（P〉0.05）,而M组在T1、T2、T3时间点的SBP、DBP和HR较T0时刻明显升高（P〈0.05）。两组插管后咽喉痛、声音嘶哑的发生率分别为6.7%（2/30）,16.7%（5/30）,差异有统计学意义（P〈0.05）。结论光棒引导气管插管在食管裂孔疝手术患者全麻气管插管中简便、易行,循环稳定且并发症少,较普通喉镜插管有明显优势。

Objective To compare the application of lightwand and direct laryngoscope in tracheal intubation in hiatal hernia patients. Methods Sixty patients scheduled for general anaesthesia with tracheal intuhation were randomly divided into two groups： the lightwand group（ group L,n = 30） and the direct laryngoscop group（ group M,n = 30）. L group with flexible Lightwand guided tracheal intubation,laryngoscope group adopted direct laryngoscope orthoptic tracheal intubation. Observe and record two groups were induced by the one-time success rate,at the sametime,before induction of anesthesia（ T0）,at intubation（ T1）,1 min after intubation（ T2）,3 min after intubation（ T3） and 5 min after intubation of SBP,DBP,Sp O2 and HR. Injury and other complications were observed after intubation without oral cavity,pharynx mucosa,teeth and gums occurred,occurred within 24 hours after the follow-up is no throat pain and hoarseness.Results The success rate of insertion of group L was 96. 7%（ 29 /30） and group M was 93. 3%（ 28 /30）;the intubation time of L group were（ 13. 5 ± 6. 1） s,and M group were（ 29. 3 ± 11. 2） s（ P〈0. 05）. In group L,T2,T3 time point of SBP,DBP and HR values of T0 had no significant difference compared with those before anesthesia（ P〉0. 05）,and In group M,T2,T3 time point of SBP,DBP and HR values of T1 increased obviously than before anesthesia,with significant difference（ P〈0. 05）. Postoperative catheter related complicationswas were 6. 7%（ 2 /30） and 16. 7%（ 5 /30） respectively,it was lower in group L than in group M（ P〈0. 05）. Conclusion The flexible Light Wand guided tracheal intubation in hiatal hernia operative issimple,easy,high success rate,less complications,which has obvious advantages than ordinary laryngoscope intubation.