李玄英 薛富善 孙海涛 张国华 刘鲲鹏 杨 冬 李成文 孙海燕 中国医学科学院中国协和医科大学整形外科医院麻醉科 北京100041 The Clinical Use of Orotracheal Intubation with Glidescope Videolaryngoscope Xuan-ying Li,Fu-shan Xue,Hai-tao Sun,Guo-hua Zhang , Kun-peng Liu,Dong Yang, Cheng-wen Li,Hai-yan Sun Department of Anesthesiology,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100041, China<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /> ABSTRACT Objective:To introduce the clinical experience of orotracheal intubation with GlideScope videolaryngoscope and observe its maneuverability,the clinical value and the cardiovascular effects in orotracheal intubation. Methods:40 patients, ASA Ⅰ~Ⅱ,aged 16~50 year-old and scheduled for selective plastic surgery, were included. The difficulty in traditional tracheal intubation was preoperatively predicted. Orotracheal intubation was done with GlideScope videolaryngoscope after rapid sequence induction of anesthesia. Noninvasive SBP,SBP,HR and SpO2 were recorded before and after induction,when the glottis was adequently visualized,when the tracheal tube was just inserted and 5 minutes after intubation with 1 minute interval. The time required for sufficient visualization of the glottis and successful tracheal intubation and the Cormack grading were also recorded. Results: The incidence of successful orotracheal intubation with GlideScope videolaryngoscope was 100%. The Cormack grading was Grade Ⅰ~Ⅱ in all patients. The times required for sufficient visualization of the glottis and for tracheal intubation were (23.68±13.44)s and (44.48±20.97)s ,respectively. Compared with those before induction, the SBP,DBP and HR when the tracheal intubation was just completed were higher, but the increases of HR and DBP were only significant statistically. Conclusion: Orotracheal intubation with GlideScope videolaryngoscope is characterized by simply manipulation , easy grasp and the clearvisualization of the glottis. Moreover,it might have some clinical value in dealing with the difficult airway. So the Glidescope videolaryngoscope should be suitable for clinical practice. Key words: Glidescope videolaryngoscope;orotracheal intubation;clinical use Corresponding author: Fushan Xue; MD; E-mail:Fruitxue@yahoo.com.cn GlideScope视频喉镜(glideScope videolaryngoscope)是加拿大Saturn生物医疗技术有限公司于2001年研制生产的1种新型视频气管插管系统(video intubation system),以其显露清晰、操作便捷等特点为临床气管插管处理提供了一种新型操作模式。我们采用该视频喉镜对40例患者实施了经口气管插管处理,对其可操作性、临床应用价值及其对心血管系统的影响进行了观察,旨在为临床安全广泛应用该新型气管插管器械提供资料。 临床资料 选择40例ASAⅠ~Ⅱ级拟行择期整形外科手术的患者,其中男17例,女23例,年龄16~50岁,体重43~97kg,身高151~181cm。在本组患者中,包括有小口畸形5例,头后仰受限6例; 手术前Mallampati舌咽结构分级[1]超过III级者为13例。 麻醉处理 手术前30 min肌内注射东莨菪碱0.3mg,患者进入手术室后连接惠普多功能监护仪连续监测SBP、DBP、MAP、HR、SpO2、和ECG,取稳定5min后的数值作为麻醉诱导前的基础对照值。建立静脉输液通道,并以5ml?kg-1?h-1的速度输注乳酸钠林格液。麻醉诱导前3min静脉注射咪达唑仑0.05mg?kg-1,采用静脉注射芬太尼2μg?kg-1、维库溴铵0.1mg?kg-1和丙泊酚2mg?kg-1进行麻醉诱导,同时应用面罩进行纯氧通气。在静脉注射维库溴铵2min后开始气管插管操作,气管插管成功后控制呼吸,潮气量10ml?kg-1,呼吸频率12次/min,新鲜气流量2.5ml?min-1,安氟烷吸入浓度为1%,O2/N2O为2/3。 气管插管操作和研究观察 一、仪器的准备 1. GlideScope视频喉镜主要包括镜片(图1A)、连接光缆、7英时LCD TFT高清晰度显示器、电源线等四部分。应用前需要按要求连接各部分,并接通电源(图1B),检查系统工作是否正常(图1B)。 2. 在镜片腹侧涂抹适量的润滑剂。 3. 选择合适型号的气管导管,在气管导管内插入插管芯,将气管导管前端塑形呈60o左右,与GlideScope视频喉镜镜片的弯曲度相适应(图2)。 4. 准备常规气管插管所需物品。 |