帝视可视喉镜与直接喉镜在腹部手术全麻气管插管中的应用比较

Comparison of Application of Dishi Visual Laryngoscope and Direct Laryngoscope in the General Anesthesia Tracheal Cannulation of Abdominal Operation

目的探讨帝视内窥式可视喉镜应用于全麻气管插管的临床效果。方法随机选取南通市肿瘤医院2016年1—6月间收治的100例择期腹部手术患者为研究对象,将患者随机分为S组和D组,每组50例,S组应用帝视内窥式喉镜引导插管,D组采用Macintoch直接喉镜进行插管。记录两组患者经口置入导管时间、插管一次性成功率及咽痛、声音沙哑、牙齿松动、口腔粘膜破损的副损伤发生率,以及麻醉诱导用药前、插管时、插管后1min的MAP与HR。结果两组患者麻醉诱导用药前和插管时MAP与HR差异无统计学意义;S组诱导前MAP、插管时MAP、插管后1 min MAP分别为(118.4±2.0)mm Hg、(87.1±5.1)mm Hg、(122.5±6.2)mm Hg,D组诱导前MAP、插管时MAP、插管后1 min MAP分别为(117.2±4.8)mm Hg、(88.4±5.7)mm Hg、(148.4±8.5)mm Hg,S组诱导前HR、插管时HR、插管后1 min HR分别为(72.2±6.8)次/min、(69.0±8.2)次/min、(73.9±5.5)次/min,D组诱导前HR、插管时HR、插管后1 min HR分别为(74.7±11.2)次/min、(70.7±8.6)次/min、(88.5±7.6)次/min,与麻醉诱导用药前相比插管时两组患者MAP,HR均明显降低;插管后1 min,D组MAP、HR明显高于诱导用药前(P<0.05),D组患者MAP、HR明显高于S组(P<0.05)。S组(19.5±6.8)s比D组(34.5±7.5)s插管时间明显缩短(P>0.001),一次性插管成功率S组98%(49/50)明显高于D组84%(42/50)(P=0.031),S组插管后咽痛、声音嘶哑、牙齿松动、口腔粘膜损伤的发生率4%(2/50)明显低于D组20%(10/50)(P=0.014)。结论与Macintoch直接喉镜比较,帝视内窥式可视喉镜在全麻插管时插管时间短,副损伤较少,患者血流动力学较稳定。

Objective To study the clinical effect of dishi visual laryngoscope in the general anesthesia tracheal cannulation of abdominal operation. Methods Random selection 100 cases of patients with selective abdominal operation patients treated in our hospital from January to June 2016 were selected and randomly divided into two groups with 50 cases in each, the S group and D group respectively adopted the dishi visual laryngoscope and Macintoch direct laryngoscope for tracheal cannulation, and the catheter placement time, disposable cannulation success rate and incidence rates of sore throat, hoarseness, loose teeth, oral mucosa damage of the two groups were recorded and the MAP and HR before anesthesia induction medication, at cannulation, at 1 min after cannulation were recorded. Results The differences in the MAP and HR before anesthesia induction medication, at cannulation, at 1 min after cannulation between the two groups were not statistically significant, and in the S group, the MAP before anesthesia induction medication, at cannulation, at 1 min after cannulation in the S group were respectively(118.4 ±2.0)mm Hg,(87.1 ±5.1) mm Hg,(122.5 ±6.2) mm Hg and in the D group were respectively(117.2±4.8)mm Hg,(88.4±5.7)mm Hg,(148.4±8.5)mm Hg, and the HR before anesthesia induction medication, at cannulation, at 1 min after cannulation were respectively(72.2 ±6.8)times/min,(69.0 ±8.2)times/min,(73.9 ±5.5)times/min and in the D group were respectively(74.7±11.2)times/min,(70.7±8.6)times/min,(88.5 ±7.6)times/min, and the MAP and HR of the two groups at cannulation obviously decreased compared with that before anesthesia induction medication, and the MAP and HR in the group D in 1 min after cannulation was obviously higher than those before induction medication(P<0.05), and the MAP and HR in the group D were obviously higher than those in the group S(P<0.05), and the cannulation time in the group S was obviously shortened compared with that in the group D[(19.5±6.8)s vs(34.5±7.5)s](P>0.001), and the disposable cannula success rate in the group S was obviously higher than that in the group D[98%(49/50) vs 84%(42/50)],(P=0.031), and the incidence rates of sore throat, hoarseness, loose teeth, oral mucosa damage after cannulation in the group S was obviously lower than that in the group D [4%(2/50) vs 20%(10/50)](P=0.014). Conclusion The cannulation time of dishi visual laryngoscope and direct laryngoscope in the general anesthesia is shorter than that of Macintoch direct laryngoscope, and the side injury is fewer and the hemodynamics of patients is steady.