摘要
目的探讨GlideScope可视喉镜联合纤维支气管镜引导在声门显露困难患者双腔支气管插管中的应用。方法选择择期行胸科手术患者40例,男24例,女16例,年龄24~78岁,ASAⅠ或Ⅱ级,MallampatiⅢ或Ⅳ级,随机分为GlideScope可视喉镜组(GF组)和Macintosh喉镜组(M组),每组20例。GF组运用可视喉镜联合纤维支气管镜引导进行支气管插管及对位;M组运用传统方法(先用Macintosh喉镜插管,再使用纤维支气管镜对位)。记录患者喉镜下声门显露程度Cormack-Lehane分级、插管时间、插管一次成功率、需喉部按压的患者例数以及术后48h内的声音嘶哑及咽痛情况。结果GF组Cormack-Lehane分级明显低于M组(P<0.01)。GF组插管时间明显短于M组[(104.3±11.1)s vs.(138.6±33.0)s](P<0.01),一次插管成功率明显高于M组(90%vs.55%)(P<0.05),需要喉部按压患者比例明显低于M组(20%vs.90%)(P<0.01),术后声音嘶哑和咽痛的发生率明显低于M组(5%vs.35%,25%vs.75%)(P<0.05)。结论与传统方法比较,可视喉镜联合纤维支气管镜引导用于声门显露困难患者可以提高插管的成功率,减少插管时的应激反应,降低声嘶和咽痛的发生率。
Objective To explore the clinical application of GlideScope video laryngoscope combined with fiberoptic bronchoscope for double-lumen endobronchial tube intubation in patients with difficult glottis exposure.Methods Forty patients undergoing scheduled for thoracic surgery（24males,16 females,aged 24-78 years,falling into ASA Ⅰ orⅡ,Mallampati classificationⅢ orⅣ,were randomly divided into two groups（n=20each）：GlideScope video laryngoscope combined with fiberoptic bronchoscope group（group GF）and Macintosh laryngoscope group（group M）.In group GF,GlideScope video laryngoscopy combined with fiberoptic bronchoscope was used to guide the double-lumen tube bronchial intubation and then bronchoscope was used to check the placement of the tube.In group M,the double-lumen endobronchial tube was intubated with conventional macintosh laryngoscope,and then the placement of the tube was checked by bronchoscope.The results of the Cormack and Lehane grade measuring the degree of glottic opening during laryngoscopy,the intubation time consumed,one-time intubation success rate,patients manoeuvre needed to aid tracheal intubation and endotracheal intubation related complications within 48 hours after operation were recorded and compared between the two groups.Results Compared with group M,the Cormack and Lehane grade was significantly better（P〈0.01）,intubation time consumed was significantly shorter[（104.3±11.1）s vs.（138.6±33.0）s]（P〈0.01）,one-time intubation success rate was higher（90% vs.55%）（P〈0.05）,fewer patients needed manoeuvre to aid tracheal intubation（20% vs.90%）（P〈0.01）and postoperative complications of hoarseness and pharyngalgia within 48 hours were significantly fewer（5% vs.35%,25% vs.75%）in group GF（P〈0.05）.Conclusion Compared with conventional method, GlideScope video laryngoscope combined with fiberoptic bronchoscope used to guide double-lumen endobronchial tube intubation in patients with difficult glottis exposure may improve the success rate
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2017年第1期26-28,共3页
Journal of Clinical Anesthesiology
