正中入路可视硬性喉镜辅助气管插管在肥胖患者中的应用

Application of visual rigid laryngoscope assisted endotracheal intubation via midline approach in obese patients

目的观察正中入路可视硬性喉镜辅助气管插管在肥胖患者中应用的难易程度。方法选择我院2017年3-9月全麻经口气管插管的患者共120例。手术前记录患者身高、体质量、体质量指数(body mass index,BMI)、颈围、甲颏间距、张口度、改良Mallampati分级、上唇咬合实验、是否为齿前突、是否打鼾、是否为小下颌。肥胖组(n=60,BMI>30)和对照组(n=60,BMI<30)均采用正中入路可视硬性喉镜辅助气管插管,记录插管次数、气管插管时间和是否需要助手辅助。结果肥胖组与对照组均出现1例患者首次插管失败,在调整喉镜角度后,第2次插管成功,首次插管成功率均为98%。肥胖组与对照组打鼾、颈围、改良Mallampati分级的差异有统计学意义(P均<0.05),需要助手辅助的次数[18次(33%)和20次(30%)]、插管时间[(28±14)s vs(26±13)s]差异无统计学意义。结论虽然肥胖患者较普通患者更易出现打鼾、颈围增加、改良Mallampati分级较高,但应用正中入路可视硬性喉镜辅助气管插管的难度并未增加。

Objective To observe the intubation difficulty of visual rigid laryngoscope via midline approach in completing endotracheal intubation in obese patients. Methods One hundred and twenty patients scheduled for surgery under general anesthesia with endotracheal intubation in Chinese PLA General Hospital from March to September in 2017 were enrolled. Before the surgery, patients＇ height, weight, body mass index, neck circumference, thyromental distance, width of mouth opening, modified Mallampati test score （MMT）, upper lip bite test, as well as incisors protrusion, snoring history and small mandibular were recorded. Both obese group （n=60, BMI ≥ 30 kg/m2） and control group （n=60, BMI 〈 30 kg/m2） had completed endotracheal intubation with visual rigid laryngoscope via midline approach. And the intubation times, the time required for intubation and whether assistance was needed were recorded. Results One case failed in the first attempt at intubation in obese group and one case in control group. While after adjusting the distal tip of the tube, the intubation was successfully completed at the second time. The first pass success （FPS） rates were both 98% in two groups. There were significant differences in snoring history, modified Mallampati test score and neck circumference between two groups （all P 〈 0.05）, while no statistically significant difference was found in the frequency of assistance （33% vs 30%, P=0.690） and the time required for intubation [（28 ± 14） s vs （26 ± 13） s, P=0.062]. Conclusion Obesity does not increase the intubation difficulty when using visual rigid laryngoscope via midline approach.