CAJ | 학술논문

目的比较Macintosh直接喉镜和帝视内窥镜用于强直性脊柱炎(ankylosing spondylitis,AS)患者经口气管插管对声门暴露的程度和插管成功率,探讨Discopo帝视内窥镜在AS患者中的应用价值. 方法选择24例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、拟在经口气管插管全身麻醉下实施择期手术的AS患者,在实施全身麻醉诱导后进行经口气管插管操作.采用完全随机方法随机应用Macintosh直接喉镜或帝视内窥镜分别显露声门并记录Cormack-Lehane分级(C/L分级).第1种喉镜显露喉部结构后不行气管插管退出喉镜,用第2种喉镜进行声门显露,记录C/L分级并行气管插管,记录气管插管时间和气管插管成功率. 结果帝视内窥镜声门显露程度(C/L分级)优于Macintosh直接喉镜(P＜0.05).Macintosh直接喉镜声门暴露时间和气管插管时间分别为(16±8)s和(45±43)s,帝视内窥镜声门暴露时间和气管插管时间分别为(13±6)s和(14±3)s,两者比较均有统计学意义(P＜0.05).Macintosh直接喉镜组气管插管成功率为83.3％(10/12),帝视内窥镜组气管插管成功率为100％(12/12)(P＜0.05). 结论采用帝视内窥镜引导AS患者经口气管插管可以在更短时间内更容易地显露声门,并提高气管插管成功率,在AS患者气管插管的处理上具有一定优势.
목적 비교Macintosh직접후경화제시내규경용우강직성척주염(ankylosing spondylitis,AS)환자경구기관삽관대성문폭로적정도화삽관성공솔,탐토Discopo제시내규경재AS환자중적응용개치. 방법 선택24례미국마취의사협회(ASA)분급Ⅰ～Ⅱ급、의재경구기관삽관전신마취하실시택기수술적AS환자,재실시전신마취유도후진행경구기관삽관조작.채용완전수궤방법수궤응용Macintosh직접후경혹제시내규경분별현로성문병기록Cormack-Lehane분급(C/L분급).제1충후경현로후부결구후불행기관삽관퇴출후경,용제2충후경진행성문현로,기록C/L분급병행기관삽관,기록기관삽관시간화기관삽관성공솔. 결과 제시내규경성문현로정도(C/L분급)우우Macintosh직접후경(P＜0.05).Macintosh직접후경성문폭로시간화기관삽관시간분별위(16±8)s화(45±43)s,제시내규경성문폭로시간화기관삽관시간분별위(13±6)s화(14±3)s,량자비교균유통계학의의(P＜0.05).Macintosh직접후경조기관삽관성공솔위83.3％(10/12),제시내규경조기관삽관성공솔위100％(12/12)(P＜0.05). 결론 채용제시내규경인도AS환자경구기관삽관가이재경단시간내경용역지현로성문,병제고기관삽관성공솔,재AS환자기관삽관적처리상구유일정우세.
Objective To evaluate the application of Discopo in orotracheal intubation in patients with ankylosing spondylitis(AS) by comparing intubation time and successful rate between Macintosh and Discopo laryngoscope.Methods Twenty-four patients (ASA Ⅰ-Ⅱ) with AS scheduled for elective operation under general anesthesia requiring orotracheal intubation were investigated.After induction and complete muscle relaxation,repeated laryngoscopy was performed using Macintosh blade and Discopo in randomized sequence before patients were intubated with the other intubation laryngoscope.Information including patient's characteristics (age,sex,BMI) and airway assessment features (Mallampati oropharyngeal grade,thyromental distance and mouth opening) were collected.Cormark-Lehane Grade (C/L Grade),best achievable glottic exposure time,time of orotracheal intubation,and successful rate of intubation were recorded.Results Discopo achieved better C/L Grade than Macintosh blade (P＜0.05).Insufficient glottic exposure,defined as C/L Grade ≥ Ⅲ,was experienced in 13 patients (54.2％) with Macintosh blade while none with Discopo.Both glottic exposure time and intubation time with Discopo [(13±6) s and (14±3) s] were less than those with Macintosh blade [(16±8) s and (45±43) s,P＜0.05].The successful rate of intubation with Discopo (100％) was higher than Macintosh blade (83.3％,P＜0.05).Conclusions Compared with direct Macintosh blade,Discopo could achieve a better glottic exposure as well as less time and higher successful rate of orotracheal intubation in patients with AS.