Shikani喉镜与Airtraq喉镜用于颈椎活动受限患者清醒气管插管对比研究

摘要

目的 比较Shikani喉镜与Airtraq喉镜清醒气管插管在颈椎手术中的应用效果. 方法 选择ASA分级Ⅰ、Ⅱ级,拟全身麻醉下行前路或后路颈椎内固定术患者60例.按随机数字表法分为Shikani喉镜组(S组)和Airtraq喉镜组(A组),每组30例.记录入室15 min麻醉诱导前(T1)、麻醉诱导后插管前(T2)、插管即刻(T3)、插管后1 min(T4)及插管后3 min(T5)时的MAP、HR、气管插管的成功率、插管时间,评估患者对气管插管的耐受性、配合程度及满意度,观察术后咽喉损伤情况. 结果 与T1比较,A组T3～T5时点MAP升高、HR增快(P＜0.05).A组T3～T5时点MAP高于S组,HR快于S组(P＜0.05).S组插管时间短于A组[(15±4)s比(22±5)s],插管成功率高于A组(100％比90％)(P＜0.05).与A组比较,S组气管插管耐受性及满意度优于A组(P＜0.05),咽喉损伤的发生率也较A组少(P＜0.05). 结论 颈椎手术清醒诱导插管中,与Airtraq喉镜比较,Shikani喉镜可减少气管插管时心血管应激反应,提高插管成功率及患者的舒适度,缩短插管时间,降低咽喉损伤的发生率.%Objective To investigate the application of awake anesthesia induction of Shikani optical stylet and Airtraq laryngoscope under the cervical spine operation.Methods Sixty patients,ASA Ⅰ or Ⅱ,under anterior or posterior cervical internal fixation operation were randomly divided into Shikani laryngoscope group (group S) and Airtraq laryngoscope group (group A) in random number table(n=30).MAP and HR were recorded at 15 min before induction of anesthesia (T1),before intubation (T2),at the immediate time of intubation(T3) and 1 min after intubation(T4),3 min after intubation(T5),the success rate of intubation,the intubation time,the tolerance,the cooperation and the satisfaction of patients with tracheal intubation were assessed,the throat injuries were observed.Results Compared with T1,MAP and HR of group A increased significantly at T3-T5 (P＜0.05).MAP and HR of group A at T3-T5 increased significantly compared with group S (P＜0.05).Intubation time in group S was shorter than that of A group[(15±4) s vs (22±5) s],the success rate of intubation of group S was higher than group A(100％ vs 90％)(P＜0.05).The tolerance,the cooperation and the satisfaction of tracheal intubation of group S were higher than group A(P＜0.05),the incidence of throat injuries were less than that of group A (P＜0.05).Conclusions Compared with the Airtraq laryngoscope,Shikani optical stylet can reduce cardiovascular response during tracheal intubation of awake anesthesia induction under cervical spine surgery,otherwise it also increase the success rate of intubation and the comfort of patients,it can shorten the intubation time,reduce the incidence of throat injuries.