经鼻型Airtraq喉镜在胸科困难气道患者气管插管中的应用

Application of Transnasal Airtraq Optical Laryngoscope on Patients with Difficult Airway Undergoing Thoracic Surgery: A Comparative Study

目的:比较成人经鼻型Airtraq喉镜与经口双腔管专用型Airtraq喉镜在胸科手术困难气道中的应用效果。方法:选择需进行双腔气管导管插管的胸科择期手术患者60例,年龄50~70岁,ASAⅠ~Ⅱ级,Mallampati分级Ⅲ或Ⅳ级,采用随机数字表法分为两组(n=30):经鼻型Airtraq喉镜组(A组)和经口双腔管专用型Airtraq喉镜组(B组)。全麻诱导后,A组用经鼻型Airtraq喉镜引导经口双腔气管导管插管,B组用经口双腔管专用型Airtraq喉镜经口双腔气管导管插管。采用声门显露程度Cormark-Lehane分级,记录插管时间、一次性气管插管成功率和插管时口唇、牙齿、牙龈、咽喉部损伤情况及插管前、插管时及插管后1min的血压和心率变化。结果:与B组比较,A组双腔气管导管插入声门时间短,一次性气管插管成功率高,插管时口唇、牙齿、牙龈、咽喉部并发症发生率低,血流动力学更平稳。结论:在需进行双腔气管导管插管的困难气道中应用经鼻型Airtraq喉镜可缩短插管时间,提高插管成功率,减轻插管所致心血管反应及插管所致口腔咽部损伤,在胸科手术双腔气管导管插管困难时及合并有心血管疾病风险的患者推荐使用。

Objective： To compare the effect of Transnasal Airtraq Optical laryngoscope and Double Lumen Airtraq Optical laryngoscope for difficult double-lumen endotracheal intubation. Methods： A total of 60 patients,of ASA I ~ Ⅱ（ Mallampati classification Ⅲ or Ⅳ）,aged 50-70 yr,scheduled for thoracic surgery under double-lumen endotracheal intubation,were randomly divided into 2 groups（ n = 30 each） using a random number table： Transnasal Airtraq Optical laryngoscope group（ group A） and Double Lumen Airtraq Optical laryngoscope group（ group B）. After induction of anesthesia,double-lumen endotracheal intubation was carried out by Transnasal Airtraq Optical laryngoscope in group A and by Double Lumen Airtraq Optical laryngoscope in group B. The exposure of the glottis was evaluated with Cormack-Lehane classification. The intubation time,rate of onetime successful intubation,intubation complications such as damage to lips,teeth,gums and soft tissues of throat during intubation were recorded. Mean arterial pressure（ MAP） and heat rate（ HR） were also recorded and analyzed before intubation,at intubation and 1 min after intubation. Results： Compared with group B,group A showed less intubation time,higher rate of onetime successful intubation,lower incidence of damage to lips,teeth,gums and soft tissues of throat during intubation,and less stimulation of haemodynamic state. Conclusion：Double-lumen endotracheal intubation for difficult airway guided by Transnasal Airtraq Optical laryngoscope can provide higher success rate,less intubation time,and milder stimuli with fewer complications than that guided by Double Lumen Airtraq Optical laryngoscope. Transnasal Airtraq Optical laryngoscope has priority in double-lumen endotracheal intubation for difficult airway and the patients complicated with angiocardiopathy.