可视喉镜与直接喉镜在急诊快速顺序插管中的比较

A comparison of the video laryngoscope with the direct laryngoscope for rapid sequence intubation

目的评估可视喉镜是否能够提高急诊患者快速顺序插管的首次插管成功率。方法150例模拟快速顺序插管的手术患者随机分为可视喉镜组和直接喉镜组(n=75)。主要观察指标为首次插管成功率,次要观察指标包括:插管时间、Cormack-Lehane喉镜暴露分级以及气管插管并发症。结果可视喉镜组首次插管成功率(98.7%)高于直接喉镜组(88.0%),差异有统计学意义(χ^2=6.857,P=0.009)。可视喉镜组插管时间[(30.4±4.5)s]比直接喉镜组插管时间[(43.6±5.2)s]短,差异有统计学意义(t=2.174,P=0.013)。可视喉镜组Cormack-Lehane喉镜暴露分级Ⅰ级和Ⅱ级的患者数为74例(98.7%),直接喉镜组Cormack-Lehane喉镜暴露分级Ⅰ级和Ⅱ级的患者数为64例(85.3%),两者比较差异有统计学意义(Z=-5.006,P<0.050)。结论与直接喉镜相比,可视喉镜用于快速顺序插管可以改善喉镜暴露条件、提高首次插管成功率以及缩短插管时间。

Objective To compare the performance of the video laryngoscope with the Macintosh direct laryngoscope for rapid sequence intubation.Methods One hundred and fifty American Society of Anesthesiologists(ASA)ⅠorⅡpatients according to ASA physical status classification system were enrolled,and 75 were randomly assigned to each of the two groups to undergo tracheal intubation using the video laryngoscope or the Macintosh direct laryngoscope.The primary outcome was the first-attempt success rate.Secondary outcomes were time to intubation,Cormack and Lehane score,and intubation complications.Results Tracheal intubation was achieved successfully at the first attempt in 74 of 75 patients in the video laryngoscope group and 64 of 75 patients in the direct laryngoscope group(χ^2=6.857,P=0.009),respectively.Compared with the direct laryngoscope group,intubation time was shorter[(30.4±4.5)vs.(43.6±5.2)s,t=2.174,P=0.013]in the video laryngoscope group.The optimal view during direct laryngoscopy was scored using Cormack-Lehane scoring system.It was significantly better in the video laryngoscope compared with the direct laryngoscope group(Z=-5.006,P<0.050).Conclusion Compared with the Macintosh direct laryngoscope,video laryngoscope for rapid sequence intubation can improve both the first-attempt success rate and optimal view of the vocal cords.