摘要
目的观察国产明视插管软镜联合可视喉镜在声门暴露困难病人双腔支气管导管插管中的临床应用效果。方法选取2017年1月至2019年4月在南方医科大学附属小榄医院择期胸外科手术需行左侧双腔支气管导管插管病人50例,均声门暴露困难。男性32例,女性18例,年龄范围为19~68岁,美国麻醉师协会分级(ASA)Ⅰ或Ⅱ级,Mallampati气道分级法Ⅲ或Ⅳ级,采用随机数字表法分为国产明视插管软镜联合可视喉镜组(V组)和Macintosh直接喉镜组(M组),每组25例。V组采用国产明视插管软镜联合可视喉镜施行双腔支气管导管插管及定位,M组先采用Macintosh直接喉镜施行双腔支气管导管插管,随后再采用国产明视插管软镜定位。观察并记录喉镜下病人声门暴露程度Cormack-Lehane分级(C-L分级)情况、气管插管时间、一次气管插管成功率、需助手按压喉部的病人例数和病人术后48 h内的声音嘶哑及咽喉痛发生情况。结果喉镜下C-L分级V组显著优于M组(P<0.05)。V组气管插管时间显著短于M组[(108.5±18.2)s比(142.6±30.8)s](P<0.05),一次气管插管成功率显著高于M组(92.0%比60.0%)(P<0.05),需助手按压喉部的病人比例显著低于M组(16.0%比92.0%)(P<0.05),V组病人术后48 h内声音嘶哑及咽喉痛发生率显著低于M组(4.0%比32.0%,24.0%比72.0%)(P<0.05)。结论与采用Macintosh直接喉镜施行双腔支气管导管插管比较,国产明视插管软镜联合可视喉镜用于声门暴露困难病人双腔支气管导管插管声门暴露好、插管时间短、一次气管插管成功率高,可降低病人术后声音嘶哑及咽喉痛的发生率。
Objective To observe the clinical effect of domestic video intubationscope(VIS)combined with video laryngoscope for double⁃lumen endobronchial tube intubation in patients with difficulty in glottis exposure.Methods Fifty patients undergoing elec⁃tive thoracic surgery in Xiaolan Hospital Affiliated to Southern Medical University from January 2017 to April 2019 were selected,all of whom had difficulty in glottis exposure,including 32 males and 18 females,aged 19⁃68,with ASAⅠorⅡ,Mallampati classi⁃ficationⅢorⅣ.Patients were randomly divided into two groups:domestic video intubationscope combined with video laryngoscope group(group V)and Macintosh direct laryngoscope(group M),with 25 cases in each group.In group V,domestic video intubation⁃scope combined with video laryngoscope was used to guide the double⁃lumen endobronchial tube bronchial intubation and then do⁃mestic video intubationscope was used to check the position of the double⁃lumen endobronchial tube.In group M,the double⁃lumen endobronchial tube was intubated with Macintosh direct laryngoscope,and then the position of the double⁃lumen endobronchial tube was checked by domestic video intubationscope.The Cormack and Lehane grade(C⁃L classification),the endotracheal intuba⁃tion time,the one⁃time endotracheal intubation success rate,the number of patients who needed pressuring on the larynx by assis⁃tant,and the occurrence of hoarseness and sore throat within 48 h after operation were observed and recorded.Results The C⁃L grade in group V was significantly better than that in group M(P<0.05).Compared with group M,the endotracheal intubation time in group V was significantly shorter[(108.5±18.2)s vs.(142.6±30.8)s](P<0.05),and the one⁃time endotracheal intubation suc⁃cess rate in group V was higher(92.0%vs.60.0%)(P<0.05),fewer patients needed pressuring on the larynx by assistant in group V(16.0%vs.92.0%)(P<0.05),and the incidence of hoarseness and sore throat within 48 h after operation was significant⁃ly lower in group V than those in group M(4.0%vs.32.0%,24.0%vs.72.0%)(P<0.05).Conclusion Compared with using Ma⁃cintosh direct laryngoscope to perform double⁃lumen endobronchial tube intubation,the application of domestic video intubation⁃scope combined with video laryngoscope in patients with difficult glottis exposure has the advantages of good glottis exposure,short intubation time,high one⁃time endotracheal intubation success rate,and may reduce the incidence of hoarseness and sore throat.
作者
许锦雄
卢增停
何绮桃
XU Jinxiong;LU Zengting;HE Qitao(Department of Anesthesiology,Xiaolan Hospital Affiliated to Southern Medical University,Zhongshan,Guangdong 528415,China)
出处
《安徽医药》
CAS
2020年第9期1779-1783,共5页
Anhui Medical and Pharmaceutical Journal
基金
广东省中山市医学科研项目(2017A020262)。
关键词
插管法
气管内/方法
明视插管软镜
可视喉镜
双腔支气管导管插管
Intubation,intratracheal/methods
Video intubationscope
Video laryngoscope
Double⁃lumen endobronchial tube intubation
