国际麻醉学与复苏杂志   2010, Issue (1): 7-9
    
GlideScope 视频喉镜在颈椎活动受限患者气管插管中的应用体会
李永华 胡永初 孙彭龄 朱秋峰 石学银 袁红斌1()
1.上海长征医院麻醉科
Experience with the GlideScope videolaryngoscopy for tracheal intubation in patients with cervical spine immobilization
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摘要:

目的 介绍新型插管工具GlideScope 视频喉镜在颈椎活动受限患者插管中的应用。方法 84 例择期或急诊颈椎手术患者,ASAI~II 级,术前存在颈椎外伤或严重的颈椎病,在快速静脉全麻诱导后先用Macintosh 喉镜暴露声门进行Cormac评级,然后运用视频喉镜进行插管,记录插管操作时间、次数和并发症,并测量诱导前(T1)、诱导后(T2)、插管时 (T3)、插管后1 min(T4)、气管插管后3 min(T5)的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压 (MAP)。结果 GlideScope 视频下Cormack 分级显著改善(P<0.05), 插管成功率为97.6%,插管时间为 12 s~135 s, 平均为(28.7±9.2)s。78 例患者1 次插管成功;4 例患者2 次插管成功;另有 2 例患者改为纤支镜插管; 82 例患者在气管插管过程中 HR、 SBP、 DBP、 ABP 平稳,插管未造成呼吸道损伤。结论 GlideScope 视频喉镜插管适合颈椎活动受限的困难气道,成功率高、插管迅速、安全性好。

关键词: GlideScope 视频喉镜;气管插管;成功率;心血管反应
Abstract:

Objective To describe the use of the GlideScope for patients with cervical spine immobilization. Methods 84 selective operation patients(ASAI-II)with cervical spine injury or severe cervical spondylosis were assigned to intubation by GlideScope videolaryngoscopy via mouth cavity after intravenous introduced general anesthesia. Prior to intubation all patients were given a Cormack grade by a senior anaesthetist using a Macintosh laryngoscopy. The patient was then intubated using GlideScope videolaryngoscopy. The procedure time of intubation, number of intubating times and the side-effects were recorded. HR, SBP, DBP, MAP were measured before(T1)and after(T2)anesthesia induction, at the beginning(T3), 1 minute(T4)and 3 minutes(T5)after tracheal intubation. Results In the GS group, Cormack grade was improved in the majority (71/84)of patients(P<0.05). The success rate was 97.6%. The procedure time of intubation was 12 s-135 s,and the average time of intuation was (28.7±9.2)s. Intubation succeed one time in 78 patients, twice in 4 patients, and two other patients were turned to fibreoptic intubation. During the intubation, the HR, SBP, DBP were stable. No injury of respiratory tract was observed. Conclusion GlideScope videolaryngoscopy introducing intubation seems a useful device in patients with cervical spine immobilization for its high successful rate, rapid intubation and excellent reliability.

Key words: GlideScope videolaryngoscopy;Tracheal intubation;Success rate;Cardiovascular response