摘要
目的比较正常气道患者GlideScope视频喉镜(GSVL)、Macintosh直接喉镜(MDLS)和光导纤维支气管镜(FOB)经口气管插管时的血液动力学反应。方法拟在经口气管插管全身麻醉下行择期整形外科手术的患者60例,ASAⅠ或Ⅱ级,年龄18-50岁,随机分为3组(n=20):GSVL组、MDLS组和FOB组。常规麻醉诱导后,分别采用GSVL、MDLS或FOB实施经口气管插管,记录麻醉诱导前(基础值)、气管插管前即刻、气管插管后即刻及插管后1、2、3、4、5min血压(BP)和心率(HR),并记录整个观察期BP和HR的最大值。计算各观察时点的收缩压×心率乘积(RPP)。以时间为横坐标、观察期BP和HR为纵坐标计算血液动力学时-效关系曲线下面积。结果与MDLS组相比,FOB组气管插管时间延长(P<0.05),气管插管后即刻HR和RPP升高(P<0.05),GSVL组各指标差异无统计学意义;与GSVL组相比,FOB组各指标差异无统计学意义;3组血液动力学时-效关系曲线下面积差异均无统计学意义。结论与MDLS和FOB相比,采用GSVL在预防正常气道患者经口气管插管时血液动力学反应方面并无明显优势,但FOB引导经口气管插管时所致的血液动力学反应却强于MDLS。
Objective To compare the hemodynamie responses to orotraeheal intubation with GlideScope video laryngoscope （GSVL）, Macintosh laryngoscope （MDLS） and fiberoptie bronehoseope （ FOB ）. Methods Sixty ASA Ⅰ orⅡ patients （21 male, 39 female） aged 18-50 yrs weighing 45-90 kg scheduled for elective plastic surgery under general anesthesia with tracheal intubation and mechanical ventilation were randomly divided into 3 groups （n = 20 each ）： GSVL group; MDLS group and FOB group. The patients were premedieated with intramuscular scopolamine 0.3 rag. Anesthesia was induced with midazolam 0.05 mg·kg^-1 , fentanyl 2 μg·kg^-1 , propofol 2 mg·kg^-1 and veeuronium 0.1 mg·kg^-1 and maintained with 1% isoflurane and 60% N20-40% 02 . Orotracheal intubation was performed at 2 min after intravenous veeuronium. Noninvasive BP and HR were recorded before and after induction of anesthesia, during tracheal intubation and at 1, 2, 3, 4, 5 rain after tracheal intubafion was completed. The HR and SBP product （RPP） was calculated. Results The intubation time was significantly longer in FOB group than in MDLS group （ P 〈 0.05）, but was not significantly different between FOB and GSVL groups and between MDLS and GSVL groups. BP and RPP were significantly decreased after induction of anesthesia, but there was no significant change in HR. Tracheal intubation caused significant increase in BP, HR and RPP as compared to the post-induction values. The highest values of HR and RPP after intubation exceeded even their baseline values before induction of anesthesia. The taehyeardia induced by intubation lasted for3-5 min. The hemodynamic responses to orotracheal intubation in GSVL group were not significantly different from those in FOB and MDLS groups but HR and RPP responses were stronger in FOB group than in MDLS group. Conclusion The hemodynamie responses produced by orotraeheal intubation using GSVL is not significantly different from those using MDLS or FOB, but FOB might bring about stronger hemodynamie responses than MDLS.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2006年第12期1069-1073,共5页
Chinese Journal of Anesthesiology
