Shikani与Macintosh两种喉镜在胸科手术患者双腔支气管插管中的比较

摘要

Objective: To compare the clinical application of shikani optical stylet (SOS) laryngoscope and macintosh direct laryngoscope(MDLS) for the placement of double-lumen endobranchial tube( DLT) during anesthesia induction in thoracic surgery. Methods: A total of 60 patients scheduled for thoracic surgery requiring one-lung ventilation were divided randomly into 2 groups (Group S and Group M) with 30 cases each. The patients in group S were intubated with SOS laryngoscope while the patients in group M were intubated with MDLS. The value of MAP, HR, SpO2 and BIS was recorded and the comparison was done between the 2 groups at following time points: the beginning of anesthetic induction ( T1 ) and intubation ( T2 ) , immediate point after intubation(T3) and 5min (T4 ) after infusion. The intubation time,the number of DLT malposition after intubation and the injuries of lip, dentition or tongue were documented and compared between the 2 groups. Results: MAP and HR immediately after intubation were significantly higher in group M than in group S ( P < 0. 05 ). The intubation time was shorter in group M than in group S(P <0. 05) . Conclusion:The hemodynamic responses at the immediate point after intubation is milder in SOS laryngoscope than in MDLS. SOS laryngoscope can reduce the intubation time for placement of double-lumen endobranchial tube comparing to MDLS.%目的:比较Shikani喉镜和Macintosh喉镜,在胸科手术患者双腔支气管插管的临床效果.方法:选择需行单肺通气的胸外科手术患者60例,随机均分为两组,Shikani喉镜组(S组)和Macintosh喉镜组(M组)各30例.麻醉诱导后分别采用Shikani喉镜或Macintosh喉镜,实施经口双腔支气管插管操作.记录并比较麻醉诱导前(T1)、气管插管前(T2)、气管插管后即刻(T3)、气管插管后5 min(T4)的平均动脉压(MAP)值、心率(HR)值和脑电双频指数(BIS)值.观察比较2组插管时间、置入目标支气管的成功率及口腔损伤出血情况.结果:在T3点,M组患者的平均动脉压(MAP)和心率(HR)均明显高于S组患者(P＜0.05),其余各时间点两组患者的血流动力学指标,差异均无统计学意义.各点脑电双频指数( BIS)值,两组间比较差异均无统计学意义.S组患者的插管时间明显＜M组(P＜0.05).进入目标支气管的成功率和口腔损伤出血情况,两组间比较差异均无统计学意义.结论:与Macintosh喉镜相比,在胸科手术患者双腔支气管插管操作过程中,使用Shikani喉镜插管对血流动力学影响更小,且插管时间更短.