可视喉镜在神经外科声门显露困难患者气管插管的应用

Application of Video Laryngoscope for Difficult Glottis Exposure in Neurosurgical Pepartment

目的比较可视喉镜与MCcoy喉镜用于神经外科声门显露困难患者气管插管的效果。方法择期行神经外科经口气管插管的全麻患者60例,Mallanpati分级Ⅲ-Ⅳ级,采用随机数字表法,将患者随机分为二组(n=30),可视喉镜组(Ⅰ组)和MCcoy喉镜组(Ⅱ组),记录声门显露时间、气管导管置入时间、气管插管情况,术后随访患者咽喉疼痛发生情况。结果两组相比,在声门显露时间、气管导管置入时间差异有统计学意义(P<0.05),咽喉疼痛可视喉镜组5例,MCcoy喉镜组6例,环状软骨按压MCcoy喉镜组11例,可视喉镜组没有。一次性置管成功率可视喉镜组100%,MCcoy喉镜组有两例二次插管。结论可视喉镜有助于神经外科声门显露困难者声门显露,且可提高气管插管的成功几率。减少了气管插管对颅内压的影响。

Objective To compare the efficacy of video laryngoscope and MCcoy laryngoscope for difficult glottis exposure in Neurosurgical patients. Methods 60 adult patients undergoing the neurosurgical surgery with general anesthesia were randomly divided into two groups （n =30）, group video soft lens （group I ） and group MCcoy laryngscope （group Ⅱ ）. The glottis exposure time, intubating conditions time from exposure of glottis to completion of tracheal intubation and incidence of postoperative sore throat were recorded and compared between the two groups. Results Through comparison, the glottis exposure time was significantly longer in group MCcoy laryngoscope （P 〈 0. 05）, and the time from exposure of glottis to completion of tracheal intubation is longer （ P 〈 0. 05 ）. There are 11 patients who have cricoid pressure in group II, and there is no patient in laryngoscope group. The rate of suc- cessful intubation at first attempt in group I is 100%, and in group II there are 2 patients undergoing the second attempt. Conclusion Video laryngoscope is superior to MCcoy laryngoscope in the management of difficult intubation in term of glottis exposure, and canincrease success rate of tracheal intubation. It reduces the influence of difficult intubation to intracranial pressure.