国产明视插管软镜与Macintosh直接喉镜经鼻气管插管的比较*

Comparison of domestic video intubationscope and Macintosh direct laryngoscope in nasal intubation*

摘要:

比较国产明视插管软镜（VIS）与Macintosh直接喉镜经鼻气管插管的临床应用效果。方法 择期口腔颌面部手术患者100例，美国麻醉医师协会（ASA）Ⅰ或Ⅱ级，年龄19～67岁，随机分为国产VIS组（V组）和Macintosh直接喉镜组（M组），每组50例。分别以国产VIS和Macintosh直接喉镜行经鼻气管插管。观察记录两组患者镜下Cormark-Lehane分级（简称C-L分级）、气管插管时间、首次气管插管成功率，观察记录麻醉诱导前（T0）、麻醉诱导后（T1）、声门显露时（T2）、插管后即刻（T3）、插管后1 min（T4）、插管后3 min（T5）的平均动脉压（MAP）和心率（HR）及气管插管相关并发症。结果 C-L分级V组明显优于M组，气管插管时间V组明显短于M组，首次气管插管成功率V组明显高于M组，差异均有统计学意义（P <0.05）。与T1时比较，V组T3～T4时MAP明显升高、T3时HR明显增快，M组T2～T4时MAP明显升高、T2～T3时HR明显增快（均P <0.05）。与M组比较，V组T2～T4时MAP和HR均明显降低（P <0.05）。气管插管并发症总发生率V组明显低于M组（P <0.05）。结论 与Macintosh直接喉镜相比较，国产VIS经鼻气管插管声门暴露好，气管插管时间短，首次气管插管成功率高，血流动力学更稳定，且气管插管并发症少，值得临床推广应用。

Abstract:

Abstract: Objective To compare the clinical effect of nasal intubation with domestic video intubationscope and Macintosh direct laryngoscope. Methods One hundred patients scheduled for oro-maxillo-facial operation, American Society of Anesthesiologists (ASA) grade I or II, aged 19 ~ 67 years, were randomly divided into the domestic video intubationscope group (group V) and the Macintosh direct laryngoscope group (group M), with 50 cases in each group. Nasal intubation was respectively performed with domestic video intubationscope (Group V) and Macintosh direct laryngoscope (group M). Cormark-Lehane grade (C-L classification), tracheal intubation time, first-time intubation success rate and tracheal intubation complications were recorded.Mean arterial pressure (MAP) and heart rate (HR) of before induction of anesthesia (T0), after induction of anesthesia (T1), at glottic exposure (T2), at intubation (T3), 1 min after intubation (T4) and 3 min after intubation (T5) were recorded. Results C-L classification in group V was significantly lower than that in group M (P < 0.05), intubation time in group V was significantly shorter than that in group M (P < 0.05), first-time intubation success rate in group V was significantly higher than that in group M (P < 0.05). Compared with T1, MAP was significantly higher at T3 ~ T4 and HR was significantly faster at T3 in group V, MAP was significantly higher at T2 ~ T4 and HR was significantly faster at T2 ~ T3 in group M (P < 0.05). Compared with group M, MAP and HR in group V were significantly lower at T2 ~ T4 (P < 0.05). The incidence of tracheal intubation complications in group V was significantly lower than that in group M (P < 0.05). Conclusions Compared with Macintosh direct laryngoscope,domestic video intubationscope in nasal intubation is better in glottic exposure,it could shorten tracheal intubation time ,increase first-time intubation success rate, maintain stable hemodynamics, has fewer tracheal intubation complications and is worthy of clinical application.