摘要
目的比较视可尼喉镜与普通直接喉镜在小儿全身麻醉气管插管中的应用价值、安全性和对应激反应的影响。方法选取需全身麻醉婴幼儿60例（其中新生儿16例）,其中男性36例,女性24例;年龄10天~3岁,平均年龄1.1岁。随机分为2组,每组30例,其中新生儿8例,其余为1个月~3岁患儿。术前处理和麻醉诱导方法相同,Ⅰ组采用视可尼喉镜进行气管插管（经口、左侧磨牙入路）,Ⅱ组则采用普通直接喉镜进行气管插管,记录各组患儿插管时间,诱导前、插管前、插管后1、3、5、10min收缩压（SBP）、舒张压（DBP）、心率（HR）,计算HR与收缩压乘积（RPP）、全程监测脉搏血氧饱和度（SpO2）并于气管插管前和气管插管后5 min采动脉血检测血糖。结果Ⅰ组患儿用视可尼喉镜行气管插管时间虽略有缩短,但差异无统计学意义。血流动力学指标：组内各时点比较,两组患儿在诱导和插管时变化过程相似,诱导后至插管前HR、SBP、DBP及RPP比麻醉前明显降低（P〈0.01）;插管后1 min的比插管前的明显增高（P〈0.01）并且达到最高,以后逐渐降低;组间比较,两组患儿在麻醉前、诱导后及插管后3、5、10 min各指标差异无统计学意义,插管后1 minⅡ组患儿的HR、SBP、DBP及RPP比Ⅰ组的明显升高,差异有统计学意义（P〈0.05）。血糖：组内、组间,两组患儿插管过程中各时点之间均无明显变化（P〉0.05）。全部病例SpO2无变化。Ⅰ组内有10例困难气道患儿全部一次性插管过程顺利,Ⅱ组内有8例困难气道患儿,其中5例一次性插管过程成功。两组比较,差异有统计学意义（P〈0.05）。结论视可尼喉镜（儿童型）用于小儿气管插管简便易行,安全可靠,尤其对声门暴露不理想者更具优势;采用视可尼喉镜实施经口气管插管可引起与用直接喉镜气管插管相似的应激反应,但相比较轻。
Objective To compare the intubation time,hemodynamic and blood glucose response for orotracheal intubation of Shikani Seeing Stylet and common direct laryngoscope,and evaluate the applicable value,safety and the effective response to stress reaction in endotracheal intubation of pediatric general anesthesia.Methods A total of 60 general anesthesia infants（16 of neonates） were enrolled,included males 36 and females 24,who were 10 days-3 years old with a mean age of 1.1.They were randomly divided into 2 groups（n = 30）,each contained 8 neonates and 22 aged 1-month to 3-year-old infants.The method of preoperative treatment and anesthesia induction was the same.Group Ⅰ performed Shikani Seeing Stylet for endotracheal intubation（from mouth,left molar）,group Ⅱ performed common direct laryngoscopes（Shucman） for endotracheal intubation.The systolic blood pressure（SBP）,diastolic blood pressure（DBP） and heart rate（HR） were recorded before induction,before intubation,and 1,3,5,10 minutes after intubation,the product of HR and systolic blood pressure（RPP） was calculated,the SpO2was monitored during the whole process,blood samples were taken from artery before and 5 minutes after endotracheal intubation for monitoring blood glucose.Results The intubation time of group Ⅰ with Shikani Seeing Stylet was shortened slightly,but there was no significant difference between two groups.In hemodynamic index,the set time between 2 groups was compared.The change process of the induction and intubation was similar between 2 groups.HR,SBP,DBP and RPP after induction and before intubation were markedly lower than that before anesthesia（P 0.01）.After intubation for 1 minute,SBP,DBP and RPP was significantly increased,reached its peak,then decreased later.After intubation for 1 minute,SBP,DBP and RPP of group Ⅰ was significantly higher than that before anesthesia（P 0.01）.Compared within groups,there was no significant difference about each index before anesthesia,after induction and 3,5,10 minutes after intubation.After intubation for 1 minute,HR,SBP,DBP and RPP of group Ⅱ was markedly increased compared to group Ⅰ,the difference showed statistical significance（P 0.05）.In blood glucose,within each group and between 2 groups,there were no significant changes during the intubation time（P 0.05）.The SpO2of all the cases was unchanged.There were 10 cases with difficult airways in group Ⅰ and the process of tracheal intubation were all one-time success.Group Ⅱ included 8 difficult airways cases,only 6 were one-time success,there was significant difference between 2 groups（P 0.05）.Conclusion It is demonstrated that Shikani Seeing Stylet（children’s types） used in tracheal intubation is very simple and safe,especially for those with glottic exposure difficulties.Adopting Shikani Seeing Stylet to incubate from the mouth could cause similar stress reaction,but the stress reaction is lighter than that of common direct laryngoscopes.
出处
《生物医学工程与临床》
CAS
2013年第3期266-270,共5页
Biomedical Engineering and Clinical Medicine
关键词
视可尼喉镜
气管插管
全身麻醉
婴幼儿
困难气道
Shikani Seeing Stylet
tracheal intubation
general anesthesia
pediatric
difficult airway
