可视喉镜与传统喉镜气管插管的急救效果比较

Comparison of the emergency effect between visual laryngoscopee and traditional laryngoscope

目的评估可视喉镜在急诊气管插管术中的临床价值和安全性。方法选取2020年6月至2021年2月赤峰学院附属医院需紧急气管插管的心脏骤停患者60例,随机数字表法分为传统喉镜(TL)组30例和可视喉镜(VL)组30例。观察两组患者喉镜显露分级、插管时间、插管成功率以及不良反应;同时按照医师职称分为低年资住院医师(A)组和高年资住院医师(B)组。结果VL组声门暴露成功率高于TL组,差异无统计学意义(P>0.05);VL组声门暴露Ⅰ级的比例明显高于传统喉镜声门暴露Ⅰ级[56.70%(17/30)比30.00%(9/30)],差异有统计学意义(P<0.05)。应用VL进行气管插管平均尝试次数、插管时间低于TL组(1.30次比1.67次、56.37 s比67.12 s),差异有统计学意义(P<0.05)。亚组分析发现应用TL进行气管插管,A组成功率、插管时间与B组(4/15比11/15、78.00 s比55.57 s)比较差异有统计学意义(P<0.05);应用VL进行气管插管,A组插管成功率上升至9/15,插管时间缩短为58.80 s,与B组比较差异无统计学意义(P>0.05)。结论VL用于急诊危重症气管插管术,改善喉镜显露分级,缩短插管时间,提高一次插管成功率,尤其是可以推广在住院医师中的应用,可以缩短与高年资医师操作差距,弥补经验不足。

Objective To investigate the effectiveness and advantage of visual laryngoscope in the treatment of patients with sudden cardiac arrest who need spontaneous respiration tracheal intubation.Methods Totally 60 patients who suffered from cardiac arrest and needed spontaneous respiration tracheal intubation were enrolled from June 2020 to February 2021 in the Affilicated Hospital of Chifeng University.Theywere randomlydivided into two groups-traditional laryngoscope(TL)group and visual laryngoscope(VL)group,with30 patients in each group.Then the success rate of glottis exposure,the operative time,success rate and complication rate of tracheal intubation were compared between the two groups.Subgroup assessment between the junior emergency resident doctor(A group)and the senior emergency resident doctor(B group)was conducted.Results According to Cormack Lehan grades,the success rate of glottis exposure in VL group was higher than that in TL group(P>0.05),and the success rate of Grade I in VL group was significant higer than that in TL group:56.70%(17/30)vs.30.00%(9/30),P<0.05.The trial times of successful intubation cases and the operative time of successful intubation cases were significantly less than those in TL group(1.30 vs 1.67,P=0.049)and(56.37 s vs 67.12 s,P<0.05).In the subgroup,the one-time success rate of tracheal intubation in A-TL group was significantly lower than that in B-TL group(4/15 vs.11/15,P<0.05),while the one-time success rate of tracheal intubation in A-VL group was 60.00%,which is lower than that in B-VL group(P>0.05).The operative time consumed for successful intubation in A-TL group was significantly longer than that in B-TL group:78.00 s vs.55.57 s,P<0.05,while the operative time in A-VL group was a little longer than that in B-VL group(P>0.05).Conclusions Visual laryngoscope used in spontaneous respiration tracheal intubation can not only increase the success rate of glottis exposure,decrease trial times and shorten operative time of intubation,but also improve the success rate and decrease the complication rate of emergency tracheal intubation.