可视喉罩与可视喉镜用于困难气管插管的比较

Comparsion of using visual laryngeal mask vs visual laryngoscopy for difficult tracheal intubation

目的比较可视喉罩和可视喉镜用于困难气管插管患者的效果。方法选择气管插管全麻手术患者90例,男27例,女63例,年龄18~64岁,BMI<30 kg/m^(2),ASAⅠ或Ⅱ级,根据术前简化气道风险指数(SARI)筛选困难气管插管患者(SARI评分≥3分)。采用随机数字表法将患者分为两组:可视喉罩组(S组)和可视喉镜组(C组),每组45例。S组使用可视喉罩引导气管插管,C组使用可视喉镜完成气管插管。记录声门暴露分级、声门暴露时间、气管插管时间、总插管时间、插管成功例数,插管前、插管即刻、插管后3 min和拔管前、拔管即刻、拔管后3 min的HR和MAP、术后插管并发症(声音嘶哑、咽喉痛)的发生情况。结果与C组比较,S组声门暴露时间[S组(18.2±7.6)s vs C组(14.1±2.8)s]明显延长(P<0.05),S组插管即刻和拔管即刻HR明显减慢,MAP明显降低(P<0.05)。两组声门暴露分级、气管插管时间、总插管时间、插管成功率和术后插管并发症发生率差异无统计学意义。结论在困难气管插管的患者中,使用可视喉罩与可视喉镜均能快速有效地完成气管插管,与可视喉镜比较,使用可视喉罩声门暴露时间延长,插管与拔管即刻血流动力学波动幅度较小。

Objective To compare the effects of visual laryngeal mask and visual laryngoscope in patients with difficult tracheal intubation.Methods Ninety patients scheduled for selective surgery under general anesthesia requiring tracheal intubation,27 males and 63 females,aged 18-64 years,BMI<30 kg/m^(2) ASA physical statusⅠorⅡ,were enrolled in the study.According to preoperative simplified airway risk index(SARI)score≥3,patients with difficult tracheal intubation were screened and divided into two groups according to random number table method:visual laryngeal mask group(group S)and visual laryngoscopy group(group C),45 patients in each group.Group S used visual laryngeal mask to guide endotracheal intubation,and group C used visual laryngoscope to complete endotracheal intubation.The gradation of glottis exposure,the exposure time of glottis,the time of endotracheal intubation,total intubation time,and the success rate of initial intubation,heart rate and blood pressure were measured before,immediately,and 3 minutes after intubation and extubation,and the incidence of postoperative intubation complications were recorded.Results Compared with group C,the glottic exposure time in group S was significantly extended[(18.2±7.6)s in group S and(14.1±2.8)s in group C](P<0.05),and HR and MAP were significantly decreased immediately after intubation and extubation in group S(P<0.05).There were no significant differences in glottis exposure grade,tracheal intubation time,total intubation time,intubation success rate,and postoperative intubation complications between the two groups.Conclusion Patients with difficult endotracheal intubation,both visual laryngeal mask and visual laryngoscope can be performed quickly and effectively.Compared with visual larygoscope,the glottis exposure time was prolonged,and the hemodynamic fluctuation range immediately after intubation and extubation was small in visual laryngeal mask.