视可尼喉镜不同光线投射区所在不同水平断面对插管效果影响

Effect of different horizontal sections of different light projection areas on intubation in Shikanioptical laryngoscope

目的探讨视可尼喉镜引导气管插管的光线投射区所在不同水平断面对气管插管的一次成功率和效果的影响。方法前瞻性研究威海市立医院2014年12月至2016年12月全身麻醉下经口气管插管行择期手术患者。根据喉镜的光线投射区所在水平断面将患者分为甲状软骨组(TC组)、甲状软骨下0.5cm组(UTC组)及梨状隐窝组(RP组)。观察指标:一次插管成功率,插管时间,心血管事件,术后并发症(包括咽痛、咽喉出血、肺炎等)。结果UTC组一次插管成功率最高(95.05%),RP组则最低(73.12%);UTC组插管时间短于TC组和RP组(P<0.05),但RP组与TC组插管时间差异无统计学意义(P>0.05)。UTC组心率和血压变化致心血管事件发生率均低于其他两组(P<0.01)。RP组咽痛和咽喉出血的发生率均高于TC组和UTC组(P<0.01);与TC组相比,UTC组咽喉出血发生率低(P<0.01),而咽痛差异无统计学意义(P>0.05);3组患者肺炎发生率差异无统计学意义(P>0.05)。结论视可尼喉镜引导气管插管光线投射区所在水平断面对插管效果有影响,将光斑投射区聚焦在甲状软骨下0.5cm水平作为插管引导的安全性及有效性最好。

Objective To investigate the effect of different horizontal sections of light projection areas on the primary success rate and intubation effect in Shikanioptical laryngoscope.Methods A prospective study was conducted on patients undergoing elective operations via oral intubation under general anesthesia in Weihai municipal hospital from December 2014 to December 2016.Patients were divided into three groups,including the thyroid cartilage group(the TC group),the 0.5 cm under thyroid cartilage group(the UTC group)and the recessus pirifomis group(the RP group),according to light projection areas.Following data were determinated:primary success rate,intubation time,cardiovascular event,postoperative complications(including sore throat,laryngeal hemorrhage,pneumonia).Results The UTC group had the highest primary success rate for intubation(95.05%),of which the RP group was the lowest(73.12%).The intubation time of the UTC group was shorter than that of the TC group and the RP group(P<0.05).However,the difference of intubation time between the RP group and the TC group was not statistically significant(P>0.05).The incidence of cardiovascular events caused by changes in heart rate and blood pressure in the UTC group was lower than that in the other two groups(P<0.01).Patients in the RP group suffered more pharyngalgia and throat bleeding than other two groups(P<0.01).There was no difference between the UTC and the TC group in the incidence of pharyngalgia(P>0.05),however,the incidence of throat bleeding was higher in the TC group(P<0.01).There was no difference among three groups in pneumonia(P>0.05).Conclusion Different horizontal sections of light projection areas has effect on the intubation effect in Shikanioptical laryngoscope.The intubation guidance with best safety and efficacy was to focus the spot projection area at the subthyroid cartilage level of 0.5 cm.