鼾症患者使用三种不同可视喉镜行经口气管插管的比较

Comparison of Clarus video stylet,HPHJ-A video laryngoscope and Airtraq laryngoscope for guiding oral tracheal intubation in patients with snoring

目的探讨Clarus可视喉镜、HPHJ-A视频喉镜和Airtraq可视喉镜在鼾症患者经口气管插管中的应用价值。方法选择拟行择期手术的鼾症患者90例,男39例,女51例,年龄22~55岁,BMI 25~29 kg/m2,ASAⅠ~Ⅲ级,随机分为三组:Clarus可视喉镜组(C组)、HPHJ-A视频喉镜组(H组)和Airtraq可视喉镜组(A组),每组30例。记录插管时间、首次插管成功率。记录麻醉诱导前(T0)、插管前(T1)、插管后即刻(T2)、插管后1 min(T3)、3 min(T4)时的HR、MAP、心率-收缩压乘积(RPP),记录咽喉损伤和出血情况。结果 C组均成功插管,H组插管失败有2例,A组插管失败有1例,后经Clarus可视喉镜均插管成功。C组插管完成时间明显长于H组和A组(P<0.05),三组插管尝试次数差异无统计学意义。与T0时比较,T1时三组HR明显减慢,MAP、RPP明显降低(P<0.05)。与T1时比较,T2时三组HR明显增快、MAP、RPP明显升高(P<0.05),T3时H组和A组HR明显增快,三组MAP和RPP明显升高(P<0.05)。T2时C组HR明显慢于H组和A组,RPP明显低于H组和A组(P<0.05)。三组咽喉损伤和出血情况等不良反应差异无统计学意义。结论对于鼾症患者行经口气管插管时,与HPHJ-A视频喉镜和Airtraq可视喉镜比较,Clarus可视喉镜所需张口度要求低,血流动力学影响小,但插管所需时间较长,在预防咽喉损伤上并无明显优势。

Objective To compare the effectiveness and feasibility of oral tracheal intubation with Clarus video stylet, HPHJ-A video laryngoscope and Airtraq laryngoscope and in snoring patients. Methods Ninety patients undergoing elective snoring surgery with general anesthesia, 39 males and 51 females, aged 22-55 years, BMI 25-29 kg/m2, ASA physical status Ⅰ-Ⅲ, were randomly divided into three equal-sized groups （n=30）： Clarus Video Stylet group （group C）, HPHJ-A video laryngoscope group （group H） and Airtraq laryngoscope group （group A）. The time of successful endotracheal intubation and the success rate of initial intubation of all groups were observed. The mean arterial pressure （MAP）, heart rate（HR） and Rate-pressure product（RPP） were also monitored before induction of anesthesia （T0）, before tracheal intubation （T1）, at 0 min （T2）, 1 min （T3）, and 3 min （T4） after intubation, as well as the throat injury and hemorrhage were noted. Results Patients in group C were successful intubated. Two patients in group H and one patient in group A with failed intubation were successfully intubated by using Clarus video stylet. The time required for successful intubation in group C was longer than groups H and A （P〈0.05）. Compared with T0, the increasing of hemodynamic parameters （MAP, HR, RPP） after induction of all groups were significant （P〈0.05）. Compared with T1, the HR, MAP and RPP were increased significantly at T2 in all groups （P〈0.05）. Compared with T1, the MAP and RPP were increased significantly at T3 in all groups, and the HR were increased significantly at T3 in groups H and A （P〈0.05）. There was no significant difference in the HR between T1 and T3 in group C. The increase in the HR and RPP at T2 was lower in group C than that in both the groups H and A （P〈0.05）. The changes of hemodynamic parameters were no significant among the three groups at other time. The differences of sore throat score and hemorrhage were no significant. Conclusion Compared with HPHJ-A video laryngoscope and Airtraq laryngoscope, Clarus video stylet for guiding oral tracheal intubation in snoring patients have less influence on hemodynamic parameters, and have no limited mouth opening. But Clarus Video Stylet spends longer intubating times, and has no obvious advantages on preventing throat injury.