视可尼喉镜梨状窝定位气管插管法在急救困难气道中的临床应用

Clinical application of piriform recess localization assisted Shikani optical stylet intubation in emergency difficult airways

目的:评价视可尼喉镜(SOS)梨状窝定位插管法在需要行急救插管的困难气道患者中的应用效果。方法:收集我院需要行急救插管通气的困难插管患者的85例,随机分为2组:视频可视喉镜引导气管插管组(V组)和视可尼喉镜引导气管插管组(S组)。所有患者均为Macintosh喉镜下插管失败及Cormack-Lehane分级C-L3-4级的患者,拟改用可视喉镜或者视可尼喉镜进行再次气管插管。插管前两组患者均采用地西泮适度镇静,V组按可视喉镜常规方法插管,S组采用视可尼喉镜梨状窝定位法进行气管插管,插管后进行机械通气。评价插管操作舒适度及插管过程中的不良事件发生率,记录气管插管成功率、气管插管时间和插管视窗。结果:与V组比较,S组一次气管插管成功率更高,气管插管时间更短,插管过程中不良事件发生率更低,术者操作舒适度更好(P<0.01),插管视窗更好(P<0.01)。结论:视可尼喉镜应用于困难气道患者急救插管效率更高,视可尼喉镜更适用于急救困难插管。

Objective: To evaluate the efficacy of piriform recess localization assisted Shikani optical styletguided emergency endotracheal intubation in difficult airway. Methods: Eighty-five patients with difficult airways requiring emergency intubation in our hospital were randomLy divided into 2 groups: Video visual laryngoscope group(group V, n=43) and Shikani Optical Stylet group(group S, n=42). All patients were failed to be Macintosh laryngoscope intubated and were in Cormack-Lehane grade C-L3-4, and all of they were planned to be tracheal intubated again with visual laryngoscope or Shikani optical stylet. Before intubation, patients in the two groups were moderately sedated with diazepam. Patients in group V were intubated according to the conventional method of visual laryngoscope, while patients in group S were intubated by the piriform recess localization method of Shikani optical stylet, and mechanical ventilation was performed after intubation. The operation comfort of the operator was evaluated, and the incidence of adverse events during intubation, tracheal intubation success rate, tracheal intubation time and intubation visual field condition were recorded. Results: Compared with group V, group S had higher success rate of first endotracheal intubation, shorter endotracheal intubation time, lower incidence of adverse events, better operation comfort and convenience(P<0.01) and better intubation window(P<0.01). Conclusion: For the patients with difficult airway, Shikani optical stylet is more effective than visual laryngoscope, and more suitable for emergency difficult intubation.