King Vision和McGrath视频喉镜在口腔颌面外科可疑困难气道患者经鼻腔插管中的应用效果评价

doi:10.19438/j.cjoms.2020.01.008

摘要/Abstract

摘要： 目的: 评估经鼻腔气管插管时,King Vision和McGrath视频喉镜在可疑困难气道患者中暴露声门的效果,探讨King Vision视频喉镜在经鼻腔气管插管中的应用价值。方法: 选择行口腔颌面手术需经鼻腔气管插管的99例患者,ASA Ⅰ或Ⅱ级。随机分为3组,每组33例,分别由经验丰富的麻醉医师在King Vision视频喉镜(K组)、McGrath视频喉镜(M组)和Macintosh直接喉镜(C组)引导下实施经鼻腔气管插管。记录气管插管时间、一次插管成功率、暴露声门时间、C-L分级、血流动力学变化、插管的辅助手段及插管并发症发生率。采用Graphpad prism 5.0软件包对3组资料进行单因素方差分析、 χ²检验和秩和检验,筛选差异指标。结果: K组和M组的气管插管时间、一次插管成功率及暴露声门时间相近且显著短于C组(P<0.05),3组血流动力学变化的最大值有统计学差异(P<0.05),插管的辅助手段及插管并发症发生率均显著低于C组(P<0.05)。结论: 与Macintosh直接喉镜相比,King Vision和McGrath视频喉镜可提供更好的插管条件。

关键词: 视频喉镜, 气管插管, 困难气道, 口腔颌面手术

Abstract: PURPOSE: King Vision and McGrath MAC video laryngoscopes (VLs) are increasingly used. The purpose of this study was to evaluate the usefulness of nasotracheal intubation in patients with predicted difficult intubations using non-channeled King Vision VL, McGrath MAC VL or Macintosh laryngoscope by experienced intubators. METHODS: The study included 99 patients requiring nasal endotracheal intubation for elective oral and maxillofacial surgery with American Society of Anesthesiologists (ASA) classification of I or II and El-Ganzouri risk index 1-7. Three groups were randomly assigned to receive nasotracheal intubation by experienced anesthesiologists guided by non-channeled King Vision video laryngoscope (K group), McGrath video laryngoscope (M group), and Macintosh laryngoscope (C group). The intubation time, success rate of primary intubation, exposure time of glottis, view of glottis opening valued by Cormack-Lehane grade, hemodynamic changes (MAP, HR), number of assisted maneuvers and incidence of side effects were recorded and compared with GraphPad Prism 5.0 software package. RESULTS: The intubation time of King Vision and McGrath group was comparable (37.6±7.3 seconds vs. 35.4±8.8 seconds) and both were significantly shorter than Macintosh group (46.8±10.4 seconds, P<0.001). Both King Vision and McGrath groups had a 100% first attempt success rate, significantly higher than Macintosh group (85%, P<0.05). The laryngoscopy time was comparable between King Vision and McGrath group (16.7±5.5 seconds vs. 15.6±6.3 seconds) and was significantly shorter than Macintosh group (22.8±7.2 seconds, P<0.05). Compared with Macintosh laryngoscope, Glottis view was obviously improved when exposed with either non-channeled King Vision or McGrath MAC VL (P<0.001), and assist maneuvers required were reduced (P<0.001). The maximum fluctuations of MAP were significantly attenuated in VL group [(47.7±12.5) mmHg and (45.1±10.3) mmHg vs. (54.9±10.2) mmHg, P<0.05 and P<0.01). Most device insertions were graded as excellent in McGrath group, followed by Macintosh and King Vision group (P=0.0014). The tube advancements were easier in VLs compared with Macintosh laryngoscope (P<0.001). Sore throat was found more frequent in Macintosh group compared with King Vision group (P<0.05). CONCLUSIONS: Compared with Macintosh laryngoscope, both King Vision and McGrath video laryngoscopes facilitated nasotracheal intubation in managing predicted difficult airways during oral and maxillofacial surgery.

Key words: Video laryngoscope, Nasotracheal intubation, Difficult airway, Oral and maxillofacial surgery

中图分类号:

R782.05.4

朱昊臻, 孙宇. King Vision和McGrath视频喉镜在口腔颌面外科可疑困难气道患者经鼻腔插管中的应用效果评价[J]. 中国口腔颌面外科杂志, 2020, 18(1): 42-47.

ZHU Hao-zhen, SUN Yu. A randomized controlled comparative study of King Vision and McGrath video laryngoscopes for nasotracheal intubation in patients with predicted difficult airways during oral and maxillofacial surgery[J]. China J Oral Maxillofac Surg, 2020, 18(1): 42-47.

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