Gerling M C, Davis D P, Hamilton R S, Morris G F, Vilke G M, Garfin S R, Hayden S R
University of California at San Diego School of Medicine, Department of Emergency Medicine, Neurosurgery, and Orthopedics, San Diego, CA, USA.
Ann Emerg Med. 2000 Oct;36(4):293-300. doi: 10.1067/mem.2000.109442.
Orotracheal intubation (OTI) is commonly used to establish a definitive airway in major trauma victims, with several different cervical spine immobilization techniques and laryngoscope blade types used. This experimental, randomized, crossover trial evaluated the effects of manual in-line stabilization and cervical collar immobilization and 3 different laryngoscope blades on cervical spine movement during OTI in a cadaver model of cervical spine injury.
A complete C5-C6 transection was performed by using an osteotome on 14 fresh-frozen cadavers. OTI was performed in a randomized crossover fashion by using both immobilization techniques and each of 3 laryngoscope blades: the Miller straight blade, the Macintosh curved blade, and the Corazelli-London-McCoy hinged blade. Intubations were recorded in real time on fluoroscopy and then transferred to video and color still images. Outcome measures included movement across C5-C6 with regard to angulation expressed in degrees of rotation and axial distraction and anteroposterior displacement with values expressed as a proportion of C5 body width. Cormack-Lehane visualization grades were also recorded as a secondary outcome measure. Data were analyzed by using multivariate analysis of variance to test for differences between immobilization techniques and between laryngoscope blades and to detect for interactions. Significance was assumed for P values of less than.05.
Manual in-line stabilization resulted in significantly less movement than cervical collar immobilization during OTI with regard to anteroposterior displacement. Use of the Miller straight blade resulted in significantly less movement than each of the other 2 blades with regard to axial distraction. The Cormack-Lehane grade was significantly better with manual in-line stabilization versus cervical collar immobilization; no differences were observed between blades.
Manual in-line stabilization results in less cervical subluxation and allows better vocal cord visualization during OTI in a cadaver model of cervical spine injury. The Miller laryngoscope blade allowed less axial distraction than the Macintosh or Corzelli-London-McCoy blades. The clinical significance of this degree of movement is unclear.
经口气管插管（OTI）常用于为严重创伤患者建立确定性气道，使用了多种不同的颈椎固定技术和喉镜叶片类型。本实验性、随机、交叉试验评估了在颈椎损伤尸体模型中，徒手直线稳定法和颈托固定以及3种不同喉镜叶片对OTI期间颈椎运动的影响。
使用骨刀对14具新鲜冷冻尸体进行C5 - C6完全横断。采用两种固定技术和3种喉镜叶片（米勒直叶片、麦金托什弯叶片和科拉泽利 - 伦敦 - 麦考伊铰链叶片）以随机交叉方式进行OTI。插管过程在荧光透视下实时记录，然后转换为视频和彩色静态图像。结果测量包括C5 - C6节段的运动，以旋转度数表示的成角、轴向牵张以及前后移位，其值以C5椎体宽度的比例表示。科马克 - 莱汉内可视分级也作为次要结果测量进行记录。使用多因素方差分析对数据进行分析，以检验固定技术之间和喉镜叶片之间的差异，并检测相互作用。P值小于0.05时认为具有统计学意义。
在OTI期间，就前后移位而言，徒手直线稳定法导致的运动明显少于颈托固定。使用米勒直叶片在轴向牵张方面导致的运动明显少于其他两种叶片。与颈托固定相比，徒手直线稳定法的科马克 - 莱汉内分级明显更好；各叶片之间未观察到差异。
在颈椎损伤尸体模型中，徒手直线稳定法在OTI期间导致颈椎半脱位较少，并能更好地观察声带。米勒喉镜叶片比麦金托什或科拉泽利 - 伦敦 - 麦考伊叶片导致的轴向牵张更少。这种运动程度的临床意义尚不清楚。
