不同可视喉镜单颅缝早闭患儿经鼻气管插管中的应用比较

Comparison of clinical effects of different video laryngoscopes in nasotracheal intubation in infants with isolated craniosynostosis

目的观察不同可视喉镜1~6个月单颅缝早闭患儿经鼻气管插管中的临床应用效果。方法选择择期全麻下行单颅缝早闭手术患儿80例,男39例,女41例,月龄1~6个月,体重4~8 kg,ASAⅠ或Ⅱ级。随机分为两组:大角度可视喉镜组(L组)和小角度可视喉镜组(S组),每组40例。麻醉诱导后,L组使用国产大角度可视喉镜,S组使用国产小角度可视喉镜,采用加强型导管行经鼻插管,导管均经柔软管芯塑形成特殊形状。记录声门暴露Cormack-Lehane(C-L)分级、插管次数,计算首次插管成功率。记录插管时间、拔管时间,插管前即刻和插管后1 min的HR、MAP、SpO_(2)。记录鼻腔出血、进入食管、咽部软组织损伤等插管时并发症和拔管后声音嘶哑情况。结果L组C-L分级Ⅰ级比例明显高于S组(P<0.05),插管时间明显短于S组(P<0.05)。两组C-L分级暴露良好(Ⅰ级和Ⅱ级)比例、首次插管成功率和拔管时间差异无统计学意义。插管后1 min S组HR明显快于L组、MAP明显高于L组(P<0.05)。S组有1例首次插管时导管误入食管,重新塑形再次插管成功。两组插管时鼻腔出血、咽部软组织损伤和拔管后声音嘶哑发生率差异无统计学意义。结论两种国产可视喉镜均可以用于1~6个月单颅缝早闭患儿的经鼻气管插管,大角度可视喉镜配套使用的镜片弯曲度大且体积相对较小,临床效果相对较好。

Objective To observe the clinical effects of different video laryngoscopes(VL)in nasotracheal intubation in infants within 6 months with isolated craniosynostosis.Methods Eighty infants with isolated craniosynostosis,39 males,41 females,aged 1-6 months,weighing 4-8 kg,ASA physical statusⅠorⅡ,scheduled for elective surgery under general anesthesia were randomly divided into 2 groups:large-angulated domestic VL group(group L)and small-angulated domestic VL group(group S),40 infants in each group.Nasotracheal intubation with reinforced tube was performed in both groups after intravenous induction.All tubes were formed into special shapes using soft stylet.The Cormack-Lehane(C-L)classification of glottis exposure,numbers of intubation were recorded,and first-attempt success rate of intubation was calculated.The parameters of time of intubation and extubation,HR,MAP,SpO_(2) immediately before and 1 minute after intubation were recorded.The incidence of complications including nose bleeding,entry into esophagus and pharynx soft tissue injury during intubation and hoarseness after extubation were also recorded.Results Compared with group S,the ration of C-L gradeⅠwas significantly higher(P<0.05),and the intubation time was significantly shorter in group L(P<0.05).There were no significant differences in C-L good exposure(the sum of that of gradesⅠandⅡ),the one-attempt success rate of intubation and extubation time between the two groups.HR was significantly faster and MAP was higher in group S than that in group L 1 minute after intubation(P<0.05).There was one case that the tube was mistakenly inserted into the esophagus during the first attempt of intubation,and successful reintubation after reshaped in group S.The incidences of nose bleeding,pharyngeal soft tissue injury and hoarseness after extubation were not significantly different in the two groups.Conclusion Both types of domestic video laryngoscopes can be used for nasotracheal intubation in infants with isolated craniosynostosis within 6 months,and the clinical effect of large-angulated VL is relatively better due to its large curvature and small size.