CAJ | 학술논문

目的比较GlideScope Ranger视频喉镜(GSVL)和直接喉镜(MDLS)经口双腔管插管时血流动力学和大脑状态指数(cerebral state index,CSI)的反应.方法拟在经口双腔管插管全身麻醉下行择期肺癌或食道癌根治术的患者48例,将患者随机分为GSVL组(24)例和MDLS组(24例).全麻诱导后采用MDLS和GSVL行喉部显露,评估声门的Cormack分级,再行气管插管,记录麻醉诱导前(T0)、气管插管前即刻(T1)、气管插管后即刻(T2)及插管后1(T3)、2(T4)、3(T5)、4(T6)、5(T7)min血压(BP)和心率(HR),并记录整个观察期BP和HR的最大值.分别于诱导前(t0)、诱导后(t1)、气管插管后1～2 min(t2)和3～5 min(t3)监测CSI的变化.结果 GSVL组的Cormack分级Ⅰ级显露率(91.7%)高于MDLS组(58.3%,P＜0.01).与T0比较,两组患者T1和T5～T7时点BP降低(P＜0.01),两组患者BP在插管后的T2～T4时点均升高,其中GSVL组BP升高程度低于MDLS组(P＜0.05);GSVL和MDLS组HR在T2～T4时点均增快,HR的最大值升高(P＜0.01),且GSVL组在T2～T4时点HR增快幅度小于MDLS组(P＜0.05).两组患者t1时点CSI均比t0时点显著降低(P＜0.01),与t1时点相比,两组t2时点CSI均升高(P＜0.01).结论采用GSVL在预防全麻诱导经口双腔管插管时血流动力学方面有较明显的优势,其声门暴露情况及对CSI的影响优于MDLS.
목적 비교GlideScope Ranger시빈후경(GSVL)화직접후경(MDLS)경구쌍강관삽관시혈류동역학화대뇌상태지수(cerebral state index,CSI)적반응.방법 의재경구쌍강관삽관전신마취하행택기폐암혹식도암근치술적환자48례,장환자수궤분위GSVL조(24)례화MDLS조(24례).전마유도후채용MDLS화GSVL행후부현로,평고성문적Cormack분급,재행기관삽관,기록마취유도전(T0)、기관삽관전즉각(T1)、기관삽관후즉각(T2)급삽관후1(T3)、2(T4)、3(T5)、4(T6)、5(T7)min혈압(BP)화심솔(HR),병기록정개관찰기BP화HR적최대치.분별우유도전(t0)、유도후(t1)、기관삽관후1～2 min(t2)화3～5 min(t3)감측CSI적변화.결과 GSVL조적Cormack분급Ⅰ급현로솔(91.7%)고우MDLS조(58.3%,P＜0.01).여T0비교,량조환자T1화T5～T7시점BP강저(P＜0.01),량조환자BP재삽관후적T2～T4시점균승고,기중GSVL조BP승고정도저우MDLS조(P＜0.05);GSVL화MDLS조HR재T2～T4시점균증쾌,HR적최대치승고(P＜0.01),차GSVL조재T2～T4시점HR증쾌폭도소우MDLS조(P＜0.05).량조환자t1시점CSI균비t0시점현저강저(P＜0.01),여t1시점상비,량조t2시점CSI균승고(P＜0.01).결론 채용GSVL재예방전마유도경구쌍강관삽관시혈류동역학방면유교명현적우세,기성문폭로정황급대CSI적영향우우MDLS.
Objective To observe the changes of haemodynamics and cerebral state index during double-lumen endobronchial intubation with glidescope ranger video laryngoscope (GSVL) and macintosh direct laryngoscope (MDLS). Methods Forty-eight ASA Ⅰ or Ⅱ patients aged 35 ～ 67 yrs were enrolled in this study, who were scheduled for elective pulmonary cancer or cancer of esophagus radical correction tients were random divided into 2 groups( n =24 each), GSVL group and MDLS group. After anesthesia was induced, all patients were given a score of Cormack grading under MDLS and GSVL, and then endobronchial intubation was performed. Noninvasive BP and HR were recorded before and after induction of anesthesia, during endobronchial intubation and after endobronchial intubation was completed for 1,2, 3, 4,5 min. The CSI was continuously monitored and recorded before and after induction of anesthesia, and after endobronchial intubation for 1 ～ 2 min and 3 ～ 5 min. Results Compared with MDLS group, the rate of Cormack grade 1 was significant higher in GSVL group (91% vs 58% ) ( P ＜0. 01 ). BP of two groups at T1 and T5 ～ T7 were significantly decreased compared to T0 values ( P ＜0. 01 ). Endobronchial intubation (T2 ～T4) caused significant increase in BP and HR compared to post-induction values(T1 ) ( P ＜0. 01).The highest values of HR after intubation exceeded even their baseline values before induction of anesthesia.The haemodynamic responses to endobronchial intubation in GSVL group at T2 ～ T4 were significantly different from those in MDLS group( P ＜0. 05). CSI of two groups at T1 was significantly decreased compared to To values( P ＜0. 01 ), CSI of two groups at T2 induced significant increase compared to T1 values, and the increase of CSI in MDLS group was stronger than that in GSVL group( P ＜0.01). Condusion The haemodynamic responses produced by orotracheal intubation using GSVL had more obvious advantages than MDLS, but GSVL seemed to provide a clear view of glottis and a little change CSI effect.