光棒引导插管在老年患者中的应用

Application of lightwand-guided intubation in elderly patients

目的:观察光棒引导插管在老年患者中的应用效果。方法:选择65~85岁拟行手术的老年患者40例,随机分为2组,每组20例。麻醉诱导后A组为光棒引导气管插管组,B组为传统喉镜经口气管插管组。分别于麻醉诱导前、气管插管后即刻、气管插管后1 min,记录收缩压(SBP)、舒张压(DBP)、心率(HR)及Sp02变化,记录插管完成时间、一次插管成功率,同时记录咽喉痛、声嘶及牙齿松动或脱落等并发症。结果:两组患者Mallampati评分差异无统计学意义(t=0.720,P>0.05)。A组气管插管后即刻、气管插管后1 min的血流动力学变化均小于B组(t=2.212,P<0.05)。A组患者插管时间明显短于B组(t=2.093,P<0.05);A组20例患者有1例发生了牙齿的松动,而B组有6例发生了牙齿松动或脱落,组间比较差异有统计学意义(χ~2=64.880,P<0.01);A组的一次插管成功率也明显高于B组(χ~2=56.711,P<0.05);A组的咽喉痛发生率也明显比B组少(χ~2=65.035,P<0.01)。结论 :在老年患者中应用光棒引导插管较使用普通喉镜能明显降低插管时的心血管反应,减少并发症,值得推广应用。

Objective： To evaluate the effect of lightwand-guided （LW） intubation on elderly patients. Methods： Forty elderly patients （65 - 85 years old） who were about to undergo surgery were randomly divided into group A and group B （n = 20 per group）. Following anesthesia, group A received LW intubation, while group B received conventional laryngoscope-guided transoral tracheal intubation. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, and SpO2 changes before anesthesia, immediately after tracheal intubation, and 1 min after tracheal intubation were recorded, along with the duration and one-time success rate of intubation. Complications such as sore throat, voice hoarseness, and loose or fallen teeth were also recorded. Results： There was no significant difference in the Mallampati score between the two groups of patients （t = 0.720,P 〉 0.05）. The hemodynamic changes immediately and at 1 min after intubation were significantly smaller in group A than in group B （t = 2.212, P 〈 0.05）. The duration of intubation was also significantly shorter in group A than in group B （t = 2.093 ,P 〈 0.05）. Furthermore, the incidence rate of loose or fallen teeth was significantly lower in group A （1 patient with loose tooth） than in group B （6 patients with loose or fallen teeth） （χ^2 = 64.880, P 〈 0.01）. The one-time intubation success rate was significantly higher in group A than in group B （χ^2 = 56.711, P 〈 0.05）, and the incidence rate of sore throat was significantly lower in group A than in group B （χ^2 = 65.035, P 〈 0.01）. Conclusions： LW intubation can significantly reduce intubation-induced cardiovascular reactions and complications in elderly patients compared with conventional intubation. Therefore, its clinical application is widely recommended.