| 摘要: |
| 目的 比较McGrath-5视频喉镜与Macintosh直接喉镜用于颈椎手术患者全麻气管插管的效果，探讨视频喉镜的安全性和优越性。方法 将ASAⅠ～Ⅲ级、进行颈椎全麻手术的40例患者按随机数字表法分为McGrath-5视频喉镜组（A组）和Macintosh直接喉镜组（B组），每组20例。采用C臂X线机拍摄两组患者诱导前头部自然位（T0）、面罩通气时（T1）、喉镜暴露声门最佳时刻（T2）、插管即刻（T3）的颈椎侧位片，用前后四线法测量各时间点颈椎屈曲度变化，气管插管困难（IDS）评分比较困难插管的情况。记录两组麻醉诱导中喉镜暴露声门的Cormark-Lehane分级、一次插管成功率、喉镜首次置入患者口腔比率及插管时使用外部压喉手法比率；记录气管插管后经颅刺激运动诱发电位阳性病例。结果两组患者在T0、T1时点颈椎屈曲度变化无统计学差异（P＞0.05）。与B组比较，A组在T2、T3时点颈椎屈曲度变化小于B组，差异有统计学意义（P＜0.05）；声门暴露Cormark-Lehane分级Ⅰ、Ⅱ级者多于B组（P＜0.05）；IDS评分A组优于B组（P＜0.05）；一次插管成功率A组（90.0%）明显高于B组（75.0%），差异有统计学意义（P＜0.05）。A组插管时需使用外部压喉手法才成功为4例（20.0%），B组为12例（60.0%），A组按压比率少于B组患者，差异有统计学意义（P＜0.05）；两组患者插管前后监测的经颅刺激运动诱发电位均无阳性病例表现。结论McGrath-5型视频喉镜用于颈椎患者气管插管，较Macintosh直接喉镜暴露好，颈椎屈曲度变化小，插管视野好，一次插管成功率高，能安全用于颈椎手术患者气管插管。 |
| 关键词: McGrath-5 视频喉镜 Macintosh 直接喉镜 颈椎手术 气管插管 |
| DOI： |
| 分类号: |
| 基金项目:余姚市科技计划项目 |
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| Comparison of McGrath-5 video laryngoscope and Macintosh direct laryngoscope for tracheal intubation in patients with cervical spine operation |
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YAN Feng, WANG Haojie
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Yuyao People's Hospital
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| Abstract: |
| Objective To compare the effect of McGrath-5 video laryngoscope and Macintosh direct laryngoscope for
tracheal intubation in patients with cervical spine operation during anesthesia induction. Methods Forty patients ASA grade I-III scheduled for cervical spine surgery under general anesthesia from July 2014 to February 2015 were randomly assigned to receive McGrath-5 video laryngoscope (group A, n=20) or Macintosh direct laryngoscope (group B, n=20) for tracheal intubation. The general information and airway assessment in two groups were compared preoperationly. Cervical spine radiographs with C-arm transmission machine were compared at the time of natural head position before induction(T0), mask ventilation (T1), best time of glottis exposure (T2) and intubation (T3) in two groups. The changes of cervical flexion at different time points were mea- sured by the four-line method pre- and after-induction. Difficult intubation score (IDS) was assessed in two groups. Cor- mark-Lehane class at glottis exposure, the successful rate of first intubation, the ratio of the first time laryngoscope into the pa- tient's mouth and pressing throat during intubation were recorded. The positive cases of transcranial stimulation motor evoked potential during intubation were recorded. Results There were no significant differences in general information and airway eval-
uating indexes in two groups (P ＞0.05), and there were no significant difference of changes in cervical flexion at T0 and T1 in two
groups (P ＞0.05). Compared with group B, cervical flexion changes at T2 and T3 in group A was less, Cormark-Lehane class in gradeⅠ+Ⅱ was more(P＜0.05), IDS score was higher(P＜0.05) and the successful rate of first intubation was significantly higher (P＜0.05) . Four cases required pressing throat during intubation in group A and 12 cases in group B (P＜0.05). There were no positive cases by transcranial magnetic stimulation monitoring of motor evoked potentials at each time points in two groups.
Conclusion Compared to Macintosh direct laryngoscope, McGrath-5 video laryngoscope for endotracheal intubation has a better exposure, smaller changes of cervical flexion degree, better intubation vision, higher ratio of first intubation success. It can be safely used for tracheal intubation in patients with cervical spine surgery. |
| Key words: McGrath-5 video laryngoscope Macintosh direct laryngoscope Cervical spine surgery Tracheal intu-
bation |
