低年资医生应用可视喉镜行气管插管的有效性及安全性研究

Efficacy and safety of with video laryngoscope guided tracheal intubation by junior doctors

摘要:

目的 对比低年资医生应用可视喉镜和直接喉镜行气管插管的有效性及安全性。方法 选取2016年4月—2018年2月沈阳军区总医院择期手术拟行全身麻醉气管插管患者240例，ASA Ⅰ～Ⅲ级，分为非困难气道组与疑似困难气道组，每组120例。亚组内随机分为直接喉镜组（D组）和可视喉镜组（V组）。患者入室后常规监测生命体征，建立外周静脉通路。在盐酸右美托咪定镇静及利多卡因充分表面麻醉下由气道专家行直接喉镜暴露分级（C～L分级）评估，剔除C～L分级Ⅳ级的患者。所有患者行标准化全身麻醉，气管插管由有3～5年临床经验的麻醉医生（以下均称低年资医生）完成。观察并记录一次性气管插管的成功率、插管时间、C～L分级、术后并发症发生率及插管前后血流动力学变化。结果 ①非困难气道组：直接喉镜与可视喉镜的一次性插管成功率、插管时间、C～L分级、术后并发症发生率、血流动力学变化比较，差异无统计学意义（P?>0.05）。②疑似困难气道组：可视喉镜的一次性插管成功率高于直接喉镜，插管时间、C～L分级及术后并发症发生率低于直接喉镜，差异有统计学意义（P?<0.05）。血流动力学变化趋势差异无统计学意义（P?>0.05）。结论 对疑似困难气道患者行择期气管插管，低年资医生使用可视喉镜的有效性和安全性均优于直视喉镜。

Abstract:

Objective To evaluate efficacy and safety of video laryngoscope guided tracheal intubation by junior doctors. Methods Totally 240 cases of general anesthesia with American Society of anesthesiologists (ASA) I-III were performed tracheal intubation. Patients were divided into non-difficult airway group and suspected difficult airway group (n?=?120). Patients in either group were randomly sub-grouped as group D and subgroup V. In subgroup D, patients received direct laryngoscope guided tracheal intubation, and patients in group V received video laryngoscope guided tracheal intubation. Peripheral venous access was established after patients’ admission, and vital signs were monitored routinely. Under sedation with dexmeimidine hydrochloride and full topical anesthesia with lidocaine, Cormach-Lehane (C-L) grading was done by airway experts using direct laryngoscopy. All patients underwent standardized general anesthesia. anesthesiologists with 3-5 years of clinical experience were identified as junior doctors. Success rate, intubation time, C-L gradation, the incidence of postoperative complications, and hemodynamic changes before and after tracheal intubation were observed and recorded during tracheal intubation. Results No statistical significant difference in success rate, intubation time, C-L gradation, postoperative complication rate or hemodynamics changes were identified between direct laryngoscope and video laryngoscope in non-difficult airway group (P?>?0.05). In suspected difficult airway group, success rate of one-time intubation was increased while intubation time, C-L gradation and incidence of postoperative complications were decreased significantly with visual laryngoscope when compared with those using direct laryngoscope (P??0.05). Conclusions Video laryngoscope is safe and effective way for tracheal intubation in patients with suspected difficult airway.