Macintosh喉镜联合纤支镜双人操作在麻醉下经口气管插管

摘要

Objective To make a contrast study between 2-peple operation of Macintosh laryngoscope combined with fiberoptic bronchoscope ( FOB) and 1-people operation of FOB in orotracheal intubation under general anesthesia .Methods 400 adult patients for selective abdominal surgery under general anesthesia ( ASAⅠtoⅡ) hospitalized from 2010 to 2011 were randomly divided into 2 groups:group A(Macintosh laryngoscope +FOB)and group B(FOB),200 in each.After intravenous anesthetic induction, endotracheal intubation was performed and Cormack-Lehane ( CL ) classification was decided by laryngoscope;the observation index included:( 1 ) demography data , mouth opening ( distance between the upper and lower incisor teeth ) , thyromental distance and Mallampati classification assessment;( 2 ) the time for glottis exposure and intubation , the successful rate of exposure for once , the successful rate of intubation for once and the intubation satisfaction scores;(3) complications related to intubation in a short time such as injuries to mouth and teeth ,blood stain on the tube ,throat pain and hoarseness .Results 392 cases(98%) were taken into statistic study;9 cases in group A(4.6%)and 8 cases in group B(4.1%)were of C-L gradeⅢ,while 4 cases in group A(2.0%)and 4 cases in group B(2.1%)were of C-L grade Ⅳ;glottis exposure and index of intubation (time and the successful rate for once )in group A were superior to those in group B,and the intubation satisfaction scores in group A were higher than those in group B (P<0.05);the occurrence of blood stain on the tube ,throat pain and hoarseness after operation was less in group A than that in group B (P<0.05). Conclusions The orotracheal intubation of FOB with the help of Macintosh laryngoscope under anesthesia can obviously raise the successful rate of intubation for once and decrease the occurrence of complications related to intubation in a short time .%目的：在麻醉下经口气管插管中，以Macintosh喉镜＋纤支镜双人操作和单人纤支镜操作进行对比研究。方法2010～2011年间连续收入的择期腹部手术的全麻成年患者400例，ASAⅠ～Ⅱ级。随机分成两组：A组双人操作Macintosh喉镜＋纤支镜，B组单人纤支镜插管，每组200例。采用静脉麻醉诱导，待患者意识丧失肌肉松弛后插入喉镜，评出Cormack-Lehane（C-L）分级。观察指标：（1）术前两组患者人口学资料、张口度、甲颏间距，并评定Mallampati分级。（2）声门暴露时间、置管时间、暴露一次成功率、置管一次成功率、插管满意度评分。（3）短期气管插管相关并发症：口齿损伤、气管导管染血、咽喉疼、声嘶。结果有392例（98％）进入统计。 A 组C-L 分级Ⅲ和Ⅳ级分别有9例（4．6％）、4例（2．0％）；B 组8例（4．1％），4例（2．1％）。声门暴露及置管指标（时间、一次成功率），A组明显优于B组（P＜0．05）；插管满意度评分，A组也显著高于B组（P＜0．05）；气管导管染血、咽喉疼及术后声嘶，A组明显少于B组（P＜0．05）。结论使用Macintosh喉镜辅助可显著提高麻醉状态下纤支镜经口气管插管的一次插管及置管成功率，并减少短期气管插管相关并发症。