可视硬性喉镜与可视喉镜在减重手术患者气管插管中的对比研究

Comparative Study of Visual Rigid Laryngoscope and Visual Laryngoscope in Tracheal Intubation in Patients Undergoing Bariatric Surgery

目的对比可视硬性喉镜与可视喉镜在减重手术患者气管插管中的应用价值。方法对照组将2020年9月~2021年7月腹腔镜胃袖状切除术随机分为2组各30例,分别采用可视硬性喉镜(硬镜组)或普通可视喉镜(对照组)进行气管插管。2组性别、年龄、身高、体重、BMI、ASA分级、气道Mallampati分级以及合并症差异无统计学意义(P>0.05)。比较2组插管时间、插管次数、插管相关并发症以及插管前后心率、平均动脉压的变化。结果硬镜组和对照组均成功插管,首次插管成功率分别为93.3%(28例)和96.7%(29例),2组差异无统计学意义(P=1.000)。硬镜组气管插管所需时间[(34.9±6.3)s]长于对照组[(31.7±5.2)s](t=2.139,P=0.037),但无临床意义。硬镜组气管黏膜损伤、声音嘶哑少于对照组(1例vs.7例、2例vs.6例),但无统计学差异(P>0.05)。2组插管后HR和MAP均明显升高,对照组升高更明显(P<0.05)。结论与普通可视喉镜相比,采用可视硬性喉镜进行气管插管对血流动力学影响轻,插管相关并发症可能更少,安全有效。

Objective To compare the application value of visual rigid laryngoscope and visual laryngoscope in tracheal intubation in patients undergoing bariatric surgery.Methods Patients undergoing laparoscopic sleeve gastrectomy in our hospital from September 2020 to July 2021 were randomly divided into two groups,with 30 cases in each group.Visual rigid laryngoscope(rigid laryngoscope group)or common visual laryngoscope(control group)were used for tracheal intubation.There were no significant differences in gender,age,height,weight,BMI,ASA grade,Mallampati grade and complications between the two groups(P>0.05).The intubation time,intubation times,intubation related complications,and heart rate(HR)and mean arterial pressure(MAP)before and after intubation were compared between the two groups.Results Intubation was successful in both the rigid laryngoscope group and the control group,and the success rate of initial intubation was 93.3%(28 cases)and 96.7%(29 cases),respectively,without statistical significance(P=1.000).The time of tracheal intubation in the rigid laryngoscope group[(34.9±6.3)s]was longer than that in the control group[(31.7±5.2)s;t=2.139,P=0.037],which had no clinical significance.The tracheal mucosa injury and hoarseness in the rigid laryngoscope group were less than those in the control group(1 case vs.7 cases,2 cases vs.6 cases),without statistical significance(P>0.05).The HR and MAP in both groups were significantly increased after intubation,especially in the control group(P<0.05).Conclusion Compared with common visual laryngoscope,the use of visual rigid laryngoscope for tracheal intubation has less impact on hemodynamics and probably less intubation-related complications,being safe and effective.