国产明视插管软镜对经口气管插管血流动力学和应激反应的影响*

Effects of china-made video intubationscope on the hemodynamics and stress response to orotracheal intubation*

摘要:

摘要：目的??观察国产明视插管软镜对全身麻醉诱导患者经口气管插管时血流动力学和应激反应的影响。方法?60例美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级择期手术患者，采用随机数字表法分为国产明视插管软镜组（V组）和Macintosh直接喉镜组（M组），每组30例。分别应用国产明视插管软镜（V组）和Macintosh直接喉镜（M组）施行经口气管插管。观察记录两组患者声门暴露时间和气管插管时间，记录两组麻醉诱导前（T1）、麻醉诱导后（T2）、声门暴露时（T3）、气管插管后1?min（T4）、3?min（T5）、5?min（T6）时收缩压（SBP）、舒张压（DBP）、心率（HR）和Narcotrend指数（NI），在T1、T4、T6时采集患者静脉血检测肾上腺素（E）、去甲肾上腺素（NE）、血浆皮质醇（CORT）的浓度。结果?两组患者声门暴露时间和气管插管时间比较差异无统计学意义（P?>0.05）。与T1时比较，T2时两组患者SBP、DBP均明显降低（P?<0.05），HR无明显变化（P?>0.05）。与T2时比较，V组T3时SBP、DBP、HR均无明显变化（P?>0.05），T4～T6时SBP、DBP和HR明显升高（P?<0.05），M组T3～T6时SBP、DBP和HR明显升高（P?<0.05），且明显高于V组（P?<0.05）。与T1时比较，T4时两组患者血浆E、NE、CORT浓度明显升高（P?<0.05）；T4、T6时M组血浆E、NE、CORT浓度明显高于V组（P?<0.05）。各时间点两组间NI比较差异无统计学意义（P?>0.05）。结论?与Macintosh直接喉镜相比较，采用国产明视插管软镜经口气管插管应激反应较轻，患者血流动力学更稳定。

Abstract:

Abstract: Objective?To investigate the effects of china-made video intubationscope on hemodynamics and stress response to orotracheal intubation in patients undergoing general anesthesia induction.?Methods?60 ASA Ⅰ or Ⅱ patients underwent elective surgery were randomly divided into china-made video intubationscope group (group V) and Macintosh direct laryngoscope (group M), 30 cases in each. Orotracheal intubation was respectively performed with china-made video intubationscope (Group V) and Macintosh Direct Laryngoscope (group M). The following data of the two groups were recorded and analyzed: glottic exposure time, tracheal intubation time. SBP, DBP, HR and NI before anesthesia induction (T1), after anesthesia induction (T2), at the glottis exposure (T3), 1 min after endotracheal intubation (T4), 3 min after endotracheal intubation (T5), 5 min after endotracheal intubation (T6). The concentration of epinephrine, norepinephrine and cortisol in the vein were measured before anesthesia induction (T1), 1 min after endotracheal intubation (T4) and 5 min after endotracheal intubation (T6).?Results?There were no significant difference in glottic exposure time and tracheal intubation time between the two groups (P?>?0.05). Compared with T1, SBP and DBP were significantly reduced in both groups (P??0.05). Compared with T2, SBP, DBP and HR in Group V were no significant changed at T3 (P?>?0.05) and were increased significantly at T4～T6 (P??0.05).?Conclusion?Compared with Macintosh direct laryngoscopy, china-made video intubationscope in orotracheal intubation is of great significance in terms of less stress response and more stable hemodynamics.