可视喉镜配合导丝与传统普通喉镜加插管钳快速诱导经鼻插管的比较

摘要

Objective To use videolaryngoscopy assisted with guide wire in nasal intubation, and to compare it with di-rect laryngoscopy assisted with intubation forceps.Methods Forty patients scheduled for oro-maxillo-facial operation were randomized into 2 groups, videolaryngoscopy group ( A) and direct laryngoscopy group ( B) .Degrees of mouth o-pening in both groups were above 2 cm.The tube in group A was curved to 120°in the anterior by a thin guide wire. Patients in group A were intubated by videolaryngoscopy assisted with guide wire, if the position was not just facing vo-cal cord, we rotated tube or adjusted the position of head to intubate.Patients in group B were intubated by direct la-ryngoscopy assisted with intubation forceps.Intubation time and first-time success rate were recorded.SBP, DBP and HR were recorded before induction of anesthesia (T1), before intubation (T2), after intubation (T3), and at 3 min after intubation.Rate of sore throat was recorded after operation.Results Intubation time in group A was significantly lower than that in group B (P<0.05).First-time success rate in group A (75%) was significant higher than that in group B (45%).Rate of sore throat in group A (25%) was similar with that in group B (30%).Cormark-Lehane classification in group A was lower than that in group B (P<0.05), SBP and HR after intubation (T3) in group A were significantly lower than those in group B (P<0.05).Conclusion Compared to direct laryngoscopy, videolaryn-goscopy is better in exposure.With the assistance of thin guide wire, it shortens intubation time, increases first-time success rate, maintains stable hemodynamics and is therefore worth for clinical popularization.%目的：尝试用可视喉镜辅以细导丝进行鼻插管，并与传统喉镜辅以插管钳做比较。方法选择口腔颌面手术患者40例，张口度均2 cm以上，随机分成可视喉镜组（ A组）和传统喉镜组（ B组）。 A组管内放入导丝，前端塑形约120°，经口放入可视喉镜，明视下经鼻送入导管，如果导管位置不正对声门，可旋转导管或调整头位，将导管送入；B组经口放入普通喉镜，在插管钳的辅助下插入导管。观察插管时间、首次成功率，喉部暴露Cormark－Lehane分级情况，分别于诱导前（T1），插管前（T2），插管后即刻（T3），插管后3 min（T4）记录两组的SBP，DBP和HR。术后随访咽痛情况。结果插管时间A组（28．32±11．25） s 明显少于B组（56．28±16．83）s，首次成功率A组（75％）明显高于B组（45％），喉部暴露Cormark－Lehane分级A组优于B组，差异均有显著性意义，P＜0．05。术后咽痛发生率A组25％，B组30％，差异无显著性意义，P＞0．05。 T3时A组SBP、HR均明显低于B组，差异有显著性意义，P＜0．05，A组血流动力学更稳定。结论可视喉镜与传统喉镜比较，喉部暴露好，辅以细导丝调节导管角度，缩短插管时间，提高了首次成功率，血流动力学更平稳，值得临床推广。