DISCOPO内镜与McCoy喉镜在困难气道清醒气管插管中的应用比较
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摘要
目的观察DISCOPO内镜与McCoy喉镜在困难气道清醒气管插管中的临床应用效果。方法将符合困难气道诊断标准的择期全麻下手术患者60例随机分为DISCOPO内镜组(D组)和McCoy喉镜组(M组),每组各30例,两组患者在表面麻醉与右美托咪定镇静的基础上,M组运用McCoy喉镜进行气管插管,D组使用DISCOPO内镜进行气管插管,记录两组患者气管插管所用时间、一次性气管插管成功率,声门暴露分级、插管并发症发生情况和围插管期血流动力学[血压(BP)和心率(HR)]变化。结果 D组气管插管时间短于M组(P <0.05),一次性插管成功率及声门暴露良好率明显高于M组(P <0.05),并发症发生率明显低于M组(P <0.05),D组T_2和T_3时间点BP和HR明显低于M组(P <0.05)。结论 DISCOPO内镜用于困难气道清醒插管用时短,成功率高,并发症少,值得临床推广应用。
Objective To compare DISCOPO endoscopy and McCoy laryngoscope in awake intubation in patients with difficult airway. Methods 60 patients with difficult airway who would have elective surgery were randomly divided into DISCOPO endoscopy group(Group D, n = 30) and McCoy group(Group M, n = 30). The patients in Group M got tracheal intubation by McCoy laryngoscope while the patients in Group D got tracheal intubation by DISCOPO after the topical tracheal anesthesia and Dexmedetomidine sedation. The time of Tracheal intubation, the first-time success rate of intubation, the Grading of glottis exposure, the adverse reactions related to intubation, blood pressure and heart rate during intubation period were observed and monitored. Results The time of tracheal intubation in Group D was obviously shorter than that in Group M(P < 0.05), the first-time success rate of intubation and the rate of low grading about glottal exposure in Group D were significantly higher than that in group M(P < 0.05). The incidence of complications in group D was significantly lower than that in group M(P < 0.01). The blood pressure and heart rate in group D were significantly lower than that in group M at T_2 and T_3 points(P < 0.01). Conclusions DISCOPO endoscope provided less intubation time, higher success rate and less complication in awake intubation in patients with difficult airway compared with McCoy laryngoscope.
Objective To compare DISCOPO endoscopy and McCoy laryngoscope in awake intubation in patients with difficult airway. Methods 60 patients with difficult airway who would have elective surgery were randomly divided into DISCOPO endoscopy group(Group D, n = 30) and McCoy group(Group M, n = 30). The patients in Group M got tracheal intubation by McCoy laryngoscope while the patients in Group D got tracheal intubation by DISCOPO after the topical tracheal anesthesia and Dexmedetomidine sedation. The time of Tracheal intubation, the first-time success rate of intubation, the Grading of glottis exposure, the adverse reactions related to intubation, blood pressure and heart rate during intubation period were observed and monitored. Results The time of tracheal intubation in Group D was obviously shorter than that in Group M(P < 0.05), the first-time success rate of intubation and the rate of low grading about glottal exposure in Group D were significantly higher than that in group M(P < 0.05). The incidence of complications in group D was significantly lower than that in group M(P < 0.01). The blood pressure and heart rate in group D were significantly lower than that in group M at T_2 and T_3 points(P < 0.01). Conclusions DISCOPO endoscope provided less intubation time, higher success rate and less complication in awake intubation in patients with difficult airway compared with McCoy laryngoscope.
引文
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[15]储勤军,贾真,谢广伦,等.Discopo可视管芯在困难气道中的应用[J].中国内镜杂志,2011,17(8):881-882.[15]CHU Q J,JIA Z,XIE G L,et al.Application of Discopo visual stylet in difficult airway[J].China Journal of Endoscopy,2011,17(8):881-882.Chinese
[16]SZARPAK L,SMEREKA J,LADNY J R.Comparison of the Intubrite and Macintosh laryngoscopes in a difficult airway scenario[J].American Journal of Emergency Medicine,2017,35(6):925.
[17]卢增停,何绮桃,涂泽华,等.国产明视插管软镜与Macintosh直接喉镜经鼻气管插管的比较[J].中国内镜杂志,2018,24(4):17-22.[17]LU Z T,HE Q T,TU Z H,et al.Comparison of domestic video intubationscope and Macintosh direct laryngoscope in nasal intubation[J].China Journal of Endoscopy,2018,24(4):17-22.Chinese
[18]马丽丽,顾连兵,高蓉,等.TOSIGHT视频喉镜与McCoy喉镜在气管插管中的应用效果[J].中华实用诊断与治疗杂志,2015,29(5):455-457.[18]MA L L,GU L B,GAO R,et al.Application of TOSIGHT video laryngoscope and McCoy laryngoscope in tracheal intubation[J].Journal of Chinese Practical Diagnosis and Therapy,2015,29(5):455-457.Chinese
[19]PIETERS B M,WILBERS N E,HUIJZER M,et al.Comparison of seven videolaryngoscopes with the Macintosh laryngoscope in manikins by experienced and novice personnel[J].Anaesthesia,2016,71(5):556-564.
[20]师小伟,顾竹劼,刁枢.帝视可视内窥镜联合右美托咪定在老年高血压患者气管插管中的应用[J].广西医学,2016,38(7):948-952.[20]SHI X W,GU Z J,DIAO S.Application of Discopo combingd with dexmedetomidine to tracheal intubation stress level in elderly patients with hypertension[J].Guangxi Medical Journal,2016,38(7):948-952.Chinese
[21]PARK S O,SHIN D H,LEEK K R,et al.Efficacy of the Disposcope endoscope,a new video laryngoscope,for endotracheal intubationin patients with cervical spine immobilisation by semirigid neckcollar:comparison with the Macintosh laryngoscope using a simulation study on a manikin[J].Emerg Med J,2013,30(4):270-274.
[2]NATT B S,MALO J,HYPES C D,et al.Strategies to improve first attempt success at intubation in critically ill patients[J].Br JAnaesth,2016,117 Suppl 1:i60-i80.
[3]HUBERT V,DUWAT A,DERANSY R,et al.Effect of simulation training on compliance with difficult airway management algorithms,technical ability,and skills retention for emergency cricothyrotomy[J].Anesthsiology,2014,120(4):999-1008.
[4]中华医学会麻醉学分会.中国麻醉学指南与专家共识(2014版)[M].北京:人民卫生出版社,2014:82-87.[4]Chinese Society of Anesthesiology.Chinese anesthesiology guide and expert consensus(2014)[M].Beijing:People’s Medical Publishing House,2014:82-87.Chinese
[5]FALCETTA S,PECORA L,ORSETTI G,et al.The Bonfils fiberscope:a clinical evaluation of its learning curve and efficacy in difficult airway management[J].Minerva Anestesiol,2012,78(2):176-184.
[6]韩红,王珑.保留呼吸慢诱导经鼻盲探气管插管在颌面外科手术中的应用[J].中国医疗前沿,2010,5(8):22.[6]HAN H,WANG L.Application of slow-breathing induction through nasal blind endotracheal intubation in maxillofacial surgery[J].National Medical Frontiers of China,2010,5(8):22.Chinese
[7]章昕,刘喜红,彭健.新型气管插管内镜与直接喉镜的对比研究[J].中国现代医学杂志,2017,27(3):45-48.[7]ZHANG X,LIU X H,PENG J.Comparison of head-flexible endoscope with direct laryngoscope in rabbit endotracheal intubation[J].China Journal of Modern Medicine,2017,27(3):45-48.Chinese
[8]王晓亮,鲍红光,赵倩,等.帝视内镜与直接喉镜对患者气管插管血流动力学影响的比较[J].中华临床医师杂志:电子版,2012,6(4):938-940.[8]WANG X L,BAO H G,ZHAO Q,et al.The clinic observation of endotracheal intubation with discope intubating device versus macintosh direct laryngoscope in general anesthesia patients[J].Chinese Journal of Clinicians:Electronic Edition,2012,6(4):938-940.Chinese
[9]王艳青,郭曲练.McCoy喉镜用于困难气管插管的临床观察[J].中国内镜杂志,2005,11(4):344-345.[9]WANG Y Q,GUO Q L.Clinical observation of McCoy laryngoscope in difficult endotracheal intubation[J].China Journal of Endoscopy,2005,11(4):344-345.Chinese
[10]YOO J Y,PARK S Y,KIM J Y,et al.Comparison of the McGrath videolaryngoscope and the Macintosh laryngoscope for double lumen endobronchial tube intubation in patients with manual in-line stabilization:a randomized controlled trial[J].Medicine(Baltimore),2018,97(10):e0081.
[11]FRERK C,MITCHELL V S,MCNARRY A F,et al.Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults[J].Br J Anaesth,2015,115(6):827-848.
[12]吴凯,李安宝,程震.帝视可视光棒在全身麻醉困难气道中的应用[J].江苏医药,2017,43(19):1435-1436.[12]WU K,LI A B,CHENG Z.Application of Disposcope light stick in the difficult airway of general anesthesia[J].Jiangsu Medical Journal,2017,43(19):1435-1436.Chinese
[13]王晓亮,葛亚力,尹加林,等.帝视内窥镜引导左侧双腔支气管导管插管的价值[J].中华麻醉学杂志,2013,33(11):1368-1371.[13]WANG X L,GE Y L,YIN J L,et al.Value of Disposcope-guided left-sided double-lumen tube intubation[J].Chinese Journal of Anesthesiology,2013,33(11):1368-1371.Chinese
[14]朱炜,骆璇.帝视内窥镜与GlideScope视频喉镜在困难气道双腔气管插管中的应用比较[J].临床麻醉学杂志,2015,31(12):1165-1167.[14]ZHU W,LUO X.Comparison of Disposcope endoscope and GlideScope video laryngoscope in the application of doublelumen endobronchial intubation in difficult airway[J].Journal of Clinical Anesthesiology,2015,31(12):1165-1167.Chinese
[15]储勤军,贾真,谢广伦,等.Discopo可视管芯在困难气道中的应用[J].中国内镜杂志,2011,17(8):881-882.[15]CHU Q J,JIA Z,XIE G L,et al.Application of Discopo visual stylet in difficult airway[J].China Journal of Endoscopy,2011,17(8):881-882.Chinese
[16]SZARPAK L,SMEREKA J,LADNY J R.Comparison of the Intubrite and Macintosh laryngoscopes in a difficult airway scenario[J].American Journal of Emergency Medicine,2017,35(6):925.
[17]卢增停,何绮桃,涂泽华,等.国产明视插管软镜与Macintosh直接喉镜经鼻气管插管的比较[J].中国内镜杂志,2018,24(4):17-22.[17]LU Z T,HE Q T,TU Z H,et al.Comparison of domestic video intubationscope and Macintosh direct laryngoscope in nasal intubation[J].China Journal of Endoscopy,2018,24(4):17-22.Chinese
[18]马丽丽,顾连兵,高蓉,等.TOSIGHT视频喉镜与McCoy喉镜在气管插管中的应用效果[J].中华实用诊断与治疗杂志,2015,29(5):455-457.[18]MA L L,GU L B,GAO R,et al.Application of TOSIGHT video laryngoscope and McCoy laryngoscope in tracheal intubation[J].Journal of Chinese Practical Diagnosis and Therapy,2015,29(5):455-457.Chinese
[19]PIETERS B M,WILBERS N E,HUIJZER M,et al.Comparison of seven videolaryngoscopes with the Macintosh laryngoscope in manikins by experienced and novice personnel[J].Anaesthesia,2016,71(5):556-564.
[20]师小伟,顾竹劼,刁枢.帝视可视内窥镜联合右美托咪定在老年高血压患者气管插管中的应用[J].广西医学,2016,38(7):948-952.[20]SHI X W,GU Z J,DIAO S.Application of Discopo combingd with dexmedetomidine to tracheal intubation stress level in elderly patients with hypertension[J].Guangxi Medical Journal,2016,38(7):948-952.Chinese
[21]PARK S O,SHIN D H,LEEK K R,et al.Efficacy of the Disposcope endoscope,a new video laryngoscope,for endotracheal intubationin patients with cervical spine immobilisation by semirigid neckcollar:comparison with the Macintosh laryngoscope using a simulation study on a manikin[J].Emerg Med J,2013,30(4):270-274.