帝视内镜与Macintosh喉镜在小儿气管插管中应用效果的比较

Comparison of application effects of Disposcope endoscope and Macintosh laryngoscope in pediatric endotracheal intubation

摘要:

目的 探讨帝视内镜在小儿扁桃体切除术中气管插管的应用效果，并与Macintosh喉镜作比较。方法 选择该院择期行扁桃体切除术的患儿60例，年龄6～9岁，美国麻醉医师协会（ASA）分级Ⅰ至Ⅱ级，Mallampati气道分级Ⅰ至Ⅱ级，扁桃体肿大Ⅰ至Ⅱ度，随机分为帝视内镜组（DE组）和Macintosh喉镜组（MA组）。全麻诱导后，分别使用帝视内镜和Macintosh喉镜行气管插管。记录两组的声门暴露时间、气管插管总时间、声门暴露分级、气管插管次数、插管并发症发生例数、各麻醉诱导时相的心率（HR）、平均动脉压（MAP）和患儿与麻醉医师口对鼻距离（MN间距）。结果 DE组声门暴露时间、气管插管总时间短于MA组（P = 0.000）；DE组声门暴露分级优于MA组（P < 0.01）；DE组均一次插管成功，MA组有3例需二次插管；DE组插管并发症发生率低于MA组（P < 0.05）；DE组MN间距明显大于MA组（P = 0.000）；两组患儿麻醉诱导前（T₀，记为基础值）、麻醉诱导后插管前即刻（T₁）和气管插管后3 min（T₄）的HR和MAP比较，差异均无统计学意义（P > 0.05）；DE组患儿气管插管后即刻（T₂）和气管插管后1 min（T₃）的HR和MAP均低于MA组（P < 0.01）。结论 相比Macintosh喉镜，在小儿扁桃体切除术气管插管时使用帝视内镜，能明显改善声门显露效果、缩短气管插管操作时间、减少插管并发症和减轻血流动力学波动，并增大MN间距。

Abstract:

Objective To investigate the effect of Disposcope endoscope on endotracheal intubation in tonsillectomy for children and compare it with Macintosh laryngoscope.Methods 60 children underwent elective tonsillectomy (aged 6~9 years, ASA grade for Ⅰ~Ⅱ, Mallampati airway grade for I~Ⅱ, grading of tonsil enlargement for Ⅰ~Ⅱ) were included into this study. The children were assigned randomly into either the Disposcope endoscope group (group DE) or the Macintosh laryngoscope group (group MA). After induction of general anesthesia, endotracheal intubations of the two groups were performed by Disposcope endoscope and Macintosh laryngoscope respectively. The glottic exposure time, total time of endotracheal intubation, glottic exposure grade, endotracheal intubation times, number of cases of intubation complications, heart rate and mean arterial pressure at each phase of anesthesia induction and the ‘mouth to nose’ distance between the child and the anesthesiologist were recorded.Results The glottic exposure time and total time of endotracheal intubation in group DE were shorter than those in group MA (P = 0.000); The glottic exposure grade in group DE was better than that in group MA (P < 0.01); All patients in group DE were successfully intubated at the first time, while 3 patients in group MA needed secondary intubation; The incidence of intubation complications in DE group was lower than that in MA group (P < 0.05); The ‘mouth-to-nose’ distance between the child and the anesthesiologist in group DE was significantly greater than that in group MA (P = 0.000); There was no significant difference in heart rate and mean arterial pressure between the two groups at T₀, T₁ and T₄, while the heart rate and mean arterial pressure of the DE group at T₂ and T₃ were lower than that of the MA group (P < 0.01).Conclusion Compared with the Macintosh laryngoscope, endotracheal intubation with Disoscope endoscope in tonsillectomy for children can significantly improve the glottis exposure effect, shorten the operation time of endotracheal intubation, reduce intubation complications, reduce hemodynamic fluctuation, and increase the ‘mouth-to-nose’ distance between the child and the anesthesiologist.