视频喉镜、直接喉镜和光导纤维支气管镜经鼻气管插管对血流动力学和炎症应激反应的比较

Comparison of video laryngoscope, direct laryngoscopy and fibreoptic bronchoscope nasal intubation on hemodynamics, inflammatory and stress response

摘要:

目的 分析视频喉镜、直接喉镜和光导纤维支气管镜（FOB）经鼻气管插管对血流动力学和炎症应激反应的影响。方法 选取2013年11月-2015年3月接受手术治疗的患者117例作为研究对象，根据接受的插管方式不同将所有入组患者随机分为视频喉镜组、直接喉镜组和FOB组。对比3组患者的插管后血流动力学、炎症反应和应激反应水平差异。结果 与T0时比较，3组患者的收缩压（SBP）、舒张压（DBP）、心率（HR）、C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子（TNF-α）、去甲肾上腺素（NE）、血浆皮质醇（Cor）和血管紧张素Ⅱ（ATⅡ）水平差异无统计学意义（P >0.05）；与直接喉镜组比较，T1、T2、T3时视频喉镜组、FOB组患者的SBP、DBP、HR、CRP、TNF-α、IL-6、NE、Cor和ATⅡ水平较低，与视频喉镜组比较，T1、T2、T3时FOB组患者的SBP、DBP、HR、CRP、TNF-α、IL-6、NE、Cor和ATⅡ水平较低（P <0.05）。结论 FOB经鼻气管插管对患者的血流动力学影响较小，不会引起严重的炎症应激反应，是全麻诱导插管的理想器械之一。

Abstract:

Objective To analyze the differences of video laryngoscope, direct laryngoscopy and fibreoptic bronchoscope nasal intubation on hemodynamics, inflammatory and stress response. Methods 117 patients underwent surgery from November 2013 to March 2015 were chose as research subjects and randomly divided into video laryngoscope group, direct laryngoscopy group, fiberoptic bronchoscope group based on different cannula enrolled way. Then compared the hemodynamics, inflammation, stress level after intubation among the three groups. Results Compared with the T0, the three groups patients' systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), C-reactive protein (CRP), interleukin -6 (IL-6), tumor necrosis factor (TNF-α), norepinephrine (NE), plasma cortisol (Cor), angiotensin Ⅱ (ATⅡ) differences had no significant difference (P > 0.05); compared with direct laryngoscopy group, video laryngoscope group, fiberoptic bronchoscope group patients' T1, T2, T3 SBP, DBP, HR, CRP, TNF-α, IL-6, NE, Cor, ATⅡ levels were lower; compared with the video laryngoscope group, optical fiber bronchoscopy group patients SBP, DBP, HR, CRP, TNF-α, IL-6, NE, Cor, ATⅡ low levels at T1, T2, T3 were lower (P < 0.05). Conclusions Fibreoptic bronchoscope nasal intubation has less influence on patients, will not cause severe stress and inflammatory response, it is one of the ideal instrument anesthesia induction intubation.