GlideScope视频喉镜和Macintosh直接喉镜在单纯唇裂婴儿全身麻醉经口气管插管中的应用

摘要

Objective:To compare the effect of intubation with the GlideScope video laryngoscope (GSVL) and Macintosh direct laryngoscope in the infants with cleft lip under general anesthesia,and compare their effects on hemodynamics.Methods:We conducted a prospective study on 60 American Society of Anesthesiologists (ASA)Ⅰ or Ⅱ infants from 4 to 10 months undergoing cheiloschisis repairing operation.The patients were randomly divided into two groups:using GlideScope video laryngoscopy (group GS) for intubation,and Macintosh Direct Laryngoscopy (group MA) for intubation.Cormack and Lehane grade (C-L grade),glottic exposure time,catheter insertion time,intubation time,success rate of intubation and the change of heart rate during the intubation time were compared between two groups.Intubation complications were classified by oral injury,dental injury,gingival injury,throat soft tissue injury,hoarseness,etc.Results:Compared with MA group,GS group could improve glottis exposure degree (P＜0.05),improve the success rate of primary intubation (P＜0.05),but prolonged glottis exposure time,catheterization time and intubation time (P＜0.05).There was no significant difference in intubation complications between the two groups (P＞0.05).The heart rate of the two groups increased rapidly after intubation,and then returned to the level after induction.When exposed glottis,tracheal intubation and immediately after intubation,the heart rate increase in GS group was significantly slower than that in MA group (P＜0.05).Conclusion:GSVL can gain better glottis exposure in the condition of assistant absence in cleft lip infants,improve the success rate of primary intubation,but prolong intubation time.%目的:通过观察GlideScope视频喉镜(GlideScope video laryngoscope,GSVL)和Macintosh直接喉镜在单纯唇裂婴儿全身麻醉经口气管插管中的应用情况,比较二者的插管效果及对血流动力学影响.方法:选取择期行单纯唇裂修复术的婴儿60例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ或Ⅱ级,月龄4～10个月,随机分为两组,全身麻醉诱导后随机采用GS VL(GS组)进行气管插管或Macintosh直接喉镜(MA组)进行气管插管,记录两组婴儿镜下Cormack and Lehane分级(C-L分级)情况、声门暴露时间、导管置入时间、插管时间、一次气管插管成功率以及观察插管过程中婴儿心率变化,并记录是否有插管并发症(口腔、牙齿、牙龈损伤,咽喉部软组织损伤,声音嘶哑等).结果:与MA组相比,GS组能提高声门暴露程度(P＜0.05),提高一次插管成功率(P＜0.05),但延长了声门暴露时间、导管置入时间和插管时间(P＜0.05),两组插管并发症相比无差异(P＞0.05).两组婴儿在插管过程中心率都表现为先增快,插管完成之后又恢复到诱导后水平,GS组在暴露声门时、气管插管时、插管后即刻心率较MA组相比明显减慢(P＜0.05).结论:在单纯唇裂婴儿全身麻醉经口气管插管中,GSVL在无助手辅助的情况下能获得更优的镜下C-L分级,提高一次插管成功率,对婴儿刺激小,但会延长插管时间.