SaCoVLM可视喉罩与Air-Q插管型喉罩用于儿童气管插管的比较研究

Comparison of SaCoVLM visual laryngeal mask and Air-Q intubation laryngeal mask for endotracheal intubation in children

目的 通过与Air-Q气管插管型喉罩的比较,评估SaCoVLM可视喉罩直视下指导儿童气管插管的临床效果。方法 选取2021年2—8月中国医学科学院北京协和医学院整形外科医院择期行全身麻醉下外耳再造手术患儿120例,采用随机数字表法分为Air-Q插管型喉罩组(A组)和SaCoVLM喉罩组(S组),每组60例。喉罩置入到位后,A组联合可视插管软镜完成插管,S组则在视频直视下实施气管插管。记录喉罩置入时间、喉罩退出时间及经喉罩气管插管时间和次数、调节手法;测量喉罩密封压;记录可视软镜在喉罩开口处的声门暴露分级、SaCoVLM可视喉罩声门暴露分级以及术后并发症的发生情况。结果 A组喉罩置入时间和喉罩退出时间短于S组[(14.1±7.2)s比(19.5±12.2)s、(18.4±5.1)s比(30.7±8.6)s],差异均有统计学意义(P<0.05);A组气管插管时间长于S组[(39.8±9.5)s比(32.4±17.1)s],差异有统计学意义(P<0.05);S组密封压高于A组[(260±52)mmH2O比(204±48)mmH2O,1 mmH2O=0.009 8 kPa],差异有统计学意义(P<0.05)。拔除喉罩后,A组有4例喉罩尖端带血,S组有8例喉罩尖端带血、10例喉罩背面带血,两组比较差异有统计学意义(P<0.05)。结论 SaCoVLM可视喉罩可在喉罩内视频的指导下直接完成气管插管,插管时间明显缩短且较Air-Q插管型喉罩,且能获得更高的密封压。而Air-Q插管型喉罩的置入和退出更为容易,损伤相对较小。

Objective To evaluate the clinical effect of SaCoVLM visual laryngeal mask under direct vision to guide children’s tracheal intubation by comparing with Air-Q intubation laryngeal mask. Methods A total of 120 children undergoing external ear reconstruction under general anesthesia were selected from February to August 2021 in Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College. They were divided into air-Q intubated laryngeal mask group(group A) and SaCoVLM laryngeal mask group(group S) by random number table method,60 cases in each group. After the laryngeal mask was placed correctly, group A performed with flexible intubation scope, and group S performed tracheal intubation under direct vision. The time of laryngeal mask insertion and withdrawal, and the time and frequency of tracheal intubation through the laryngeal mask, as well as the adjustment methods were recorded. The sealing pressure of the laryngeal mask was measured. The glottal exposure grading at the opening of the laryngeal mask, the SaCoVLM laryngeal mask display on-screen glottal exposure classification and the occurrence of postoperative complications were observed and recorded. Results The laryngeal mask insertion time and laryngeal mask withdrawal time in group A were shorter than those in group S [(14.1 ± 7.2) s vs.(19.5 ± 12.2) s,(18.4 ± 5.1) s vs.(30.7 ± 8.6) s], the differences were statistically significant(P < 0.05). The tracheal intubation time of group A was higher than that of group S [(39.8 ± 9.5) s vs.(32.4 ± 17.1) s], the difference was statistically significant(P<0.05). The sealing pressure of group S was higher than that of group A [(260 ± 52) mmH2O vs.(204 ± 48) mmH2O, 1 mmH2O = 0.009 8 kPa], the difference was statistically significant(P<0.05). After removal of the laryngeal mask, there were four cases with blood at the tip of the mask in group A, eight cases with blood at the tip of the laryngeal mask and 10 cases with blood at the back of the laryngeal mask in group S, and the difference between the two groups was statistically significant(P < 0.05). Conclusions The SaCoVLM visual laryngeal mask can directly complete the tracheal intubation under the guidance of the video in the laryngeal mask. The intubation time is significantly shortened and the sealing pressure can be higher than that of the Air-Q laryngeal mask. The Air-Q laryngeal mask is easier to insert and withdraw, and the damage is relatively small.