不同体位下可视软镜引导气管插管的临床效果比较

Comparison of clinical efficacy of video airwayscope-guided endotracheal intubation in different positions

目的比较不同体位下可视软镜引导气管插管的临床效果。方法选择240例择期手术患者,患者年龄18~76岁,术前评估咽部结构MallampattiⅠ~Ⅲ级,分为A组、B组和C组,每组各80例。所有患者行全身麻醉后采用可视软镜引导经口气管插管,其中A组取左侧卧位、颈部垫枕、保持颈部水平位、头后仰,B组取右侧卧位、颈部垫枕、保持颈部水平位、头后仰,C组取头去枕平卧中立位。分别记录3组在麻醉前(T0)、插管时(T1)、插管后1 min(T2)、插管后5 min(T3)的血压、心率、Sa O2,比较3组患者的插管时间、1次插管成功率,观察插管所致的不良反应。结果 240例患者均顺利完成经口气管插管。3组患者各时点的血压、心率、Sa O2组间比较差异均无统计学意义(P均>0.05);与T0比较,3组患者的T1~T3时点舒张压及收缩压均明显降低,心率明显减慢(P均<0.0125);手术期间,3组患者的Sa O2无变化(P>0.05)。A组和B组1次插管成功率均高于C组(P均<0.017)。A组成功插管时间最短,与B、C组比较差异均有统计学意义(P均<0.05)。C组术后24 h吞咽时咽喉痛和声音嘶哑发生率均明显高于A组和B组(P<0.017)。结论侧卧位使用可视软镜引导气管插管的插管成功率高、插管时间较快,且明显减少术后24 h吞咽时咽喉痛,不影响患者的呼吸。

Objective To compare the clinical efficacy of video airwayscope-guided endotracheal intubation in different positions. Methods In total, 240 patients scheduled to undergo surgery, aged 18-76 years, diagnosed with Class Ⅰ-Ⅲ by Mallampati scoring before surgery, were recruited and divided into groups A, B and C （n=80）. All patients received video airwayscope-guided orotracheal intubation under general anesthesia. In group A, patients were kept in left lateral position with a pillow placed beneath the neck to maintain the neck level and the head backwards. In group B, patients were in right lateral position with a pillow placed under the neck to maintain the neck level and the head backwards. In group C, patients were kept in a supine position. The blood pressure, heart rate and SaO2 level were recorded before anesthesia （T0）, during intubation （T1）, 1 min after intubation （T2） and 5 min after intubation （T3）, respectively. The intubation time and the success rate of the first intubation were statistically compared among three groups. The incidence of intubation-induced adverse reaction was observed. Results All 240 patients successfully underwent the orotracheal intubation. No statistical significance was observed in the blood pressure, heart rate and SaO2 level at each time point among different groups （all P〉0.05）. At T1 to T3 time points, the diastolic and systolic blood pressure was significantly reduced and the heart rate was significantly slow down compared with those detected at T0 time point （all P 〈 0.0125）. Intraoperatively, the SaO2 levels did not significantly change among three groups （all P〉0.05）. In groups A and B, the success rate of the first intubation was significantly higher than that in group C （both P 〈 0.017）. The intubation time in group A was significantly shorter compared with that in groups B and C （both P 〈 0.05）. In group C, the incidence of sore throat and hoarseness at postoperative 24 h was significantly higher than that in groups A and B （both P 〈 0.017）. Conclusions Application of video airwayscope-guided endotracheal intubation in lateral position yields high success rate and short intubation time, which significantly decreases the risk of sore throat at postoperative 24 h and does not affect respiration.