McGrath-5型视频喉镜与McCoy喉镜引导困难气道双腔支气管插管的效果比较*

摘要： 目的 探讨McGrath-5型视频喉镜与McCoy喉镜在困难气道双腔支气管插管的临床应用效果。方法 选择预计双腔支气管插管困难的择期手术患者60例，采用随机数字表法，将其随机分为两组：McGrath-5型视频喉镜组（A组，n =30）和McCoy喉镜组（B组，n =30）。常规诱导后分别用两种喉镜引导经口插管，对两组患者一次插管成功率、插管时间、定位成功率、插管时间内脉搏血氧饱和度（SpO2）<90%次数、环状软骨按压例数、插管并发症发生情况和血流动力学指标：诱导前（T0）、置入喉镜暴露声门时（T1）、导管进入声门即刻（T2）、插管后3 min（T3）各时间点记录患者收缩压（SBP）、心率（HR）和脑电双频指数（BIS）值的变化进行分析。结果 A组患者环状软骨按压例数明显低于B组（P <0.05），插管时间明显高于B组（P <0.05）；两组患者T3时点的SBP和HR较T0时点均明显降低（P <0.05），A组患者T1、T2时点SBP和HR均明显低于B组（P <0.05）。结论 与McCoy喉镜相比，McGrath-5型视频喉镜引导经口双腔导管插管对血流动力学的影响较小，插管并发症较少，插管时间虽延长但不至于影响患者氧供，为临床解决困难气道双腔插管提供一种良好选择。
Abstract: Objective?To compare the clinical efficacy of double-lumen tube intubation between McGrath-5 video-laryngoscope and McCoy laryngoscope in patients with difficult airway. Methods Sixty patients who were predicted as difficult double-lumen tube intubation were divided into two groups using random number table method: McGrath-5 video-laryngoscope group (group A, n = 30) and McCoy laryngoscope group (group B, n = 30). All patients were intubated by two laryngoscopes correspondingly after conventional induction. The success rate of the first intubation, intubation time, the ratio of right positioning, the number of SpO2 < 90% within intubation time, the number of pressing the cricoid, the incidence of intubation complications and hemodynamic parameters [The changes in systolic pressure and heart rate and BIS were recorded before induction (T0), glottic exposure upon laryngoscope insertion (T1), immediately after intubation (T2), 3 min (T3) after intubation]. Results The number of pressing the cricoid was smaller in group A than in group B (P < 0.05), whereas the intubation time in group A was significantly higher than that in group B (P < 0.05). The systolic pressure and heart rate at T3 were dramatically reduced compared with those measured at T0 in both groups (P < 0.05). The systolic pressure and heart rate at T1 and T2 in group A were considerably lower in group A than those in group B (P < 0.05). Conclusions Compared with the McCoy laryngoscope, double-lumen tube intubation by McGrath-5 video-laryngoscope can less impact on hemodynamics, less intubation complications, intubation time although prolonged but not for influence the patient's oxygen supply, for difficult airway double-lumen tube intubation provides a good choice.