【摘要】 目的尝试用可视喉镜辅以细导丝进行鼻插管,并与传统喉镜辅以插管钳做比较。方法选择口腔颌面手术患者40例,张口度均2 cm以上,随机分成可视喉镜组(A组)和传统喉镜组(B组)。A组管内放入导丝,前端塑形约120°,经口放入可视喉镜,明视下经鼻送入导管,如果导管位置不正对声门,可旋转导管或调整头位,将导管送入;B组经口放入普通喉镜,在插管钳的辅助下插入导管。观察插管时间、首次成功率,喉部暴露Cormark-Lehane分级情况,分别于诱导前(T1),插管前(T2),插管后即刻(T3),插管后3 min(T4)记录两组的SBP,DBP和HR。术后随访咽痛情况。结果插管时间A组(28.32±11.25)s明显少于B组(56.28±16.83)s,首次成功率A组(75%)明显高于B组(45%),喉部暴露Cormark-Lehane分级A组优于B组,差异均有显著性意义,P<0.05。术后咽痛发生率A组25%,B组30%,差异无显著性意义,P>0.05。T3时A组SBP、HR均明显低于B组,差异有显著性意义,P<0.05,A组血流动力学更稳定。结论可视喉镜与传统喉镜比较,喉部暴露好,辅以细导丝调节导管角度,缩短插管时间,提高了首次成功率,血流动力学更平稳,值得临床推广。更多还原

【Abstract】 Objective To use videolaryngoscopy assisted with guide wire in nasal intubation,and to compare it with direct laryngoscopy assisted with intubation forceps. Methods Forty patients scheduled for oro- maxillo- facial operation were randomized into 2 groups,videolaryngoscopy group( A) and direct laryngoscopy group( B). Degrees of mouth opening in both groups were above 2 cm. The tube in group A was curved to 120° in the anterior by a thin guide wire.Patients in group A were intubated by videolaryngoscopy assisted with guide wire,if the position was not just facing vocal cord,we rotated tube or adjusted the position of head to intubate. Patients in group B were intubated by direct laryngoscopy assisted with intubation forceps. Intubation time and first- time success rate were recorded. SBP,DBP and HR were recorded before induction of anesthesia( T1),before intubation( T2),after intubation( T3),and at 3 min after intubation. Rate of sore throat was recorded after operation. Results Intubation time in group A was significantly lower than that in group B( P < 0. 05). First- time success rate in group A( 75%) was significant higher than that in group B( 45%). Rate of sore throat in group A( 25%) was similar with that in group B( 30%). Cormark- Lehane classification in group A was lower than that in group B( P < 0. 05),SBP and HR after intubation( T3) in group A were significantly lower than those in group B( P < 0. 05). Conclusion Compared to direct laryngoscopy,videolaryngoscopy is better in exposure. With the assistance of thin guide wire,it shortens intubation time,increases first- time success rate,maintains stable hemodynamics and is therefore worth for clinical popularization.更多还原