经鼻气管插管时气管内的“导管刮擦”：Macintosh喉镜与McCoy喉镜的比较

["Tube scratching" in the trachea on nasotracheal intubation: comparison of Macintosh and McCoy laryngoscopes].

作者信息

Mizogami Maki, Sakata Tsuneyasu, Ooshima Kazuyuki, Ono Yasushi, Harada Jun

机构信息

Department of Anesthesiology, Asahi University School of Dentistry, Gifu 501-0296.

出版信息

Masui. 2003 Jan;52(1):37-41.

PMID:12632618

Abstract

BACKGROUND

"Tube scratching" in the trachea, the intratracheal resistance of a tube, on nasotracheal intubation was evaluated using the Macintosh and the McCoy laryngoscope blade.

METHODS

Fifty young patients requiring nasotracheal intubation were studied. Following induction of anesthesia, X-ray was taken before and during the use of two types of laryngoscopes. For analysis of the configuration of the upper airway, we drew three straight lines [axis of pharynx (P), larynx (L) and trachea (T)] on each film. "Tube scratching" was evaluated and graded to four by a supporting anesthesiologists.

RESULTS

"Tube scratching" in the trachea was observed in 14/25 patients with McCoy laryngoscope and 4/25 patients with Macintosh laryngoscope (P < 0.05). Intubation with McCoy laryngoscope decreased more the angles formed by P and L, and L and P those that with Macintosh laryngoscope (P < 0.01). These data indicate that the lines of P, L and T tend not to align with McCoy laryngoscope, preventing the tracheal tube to be passed smoothly.

CONCLUSION

An excessive lifting of the epiglottis, often observed in using McCoy laryngoscope, causes "Tube scratching" in the trachea on nasotracheal intubation.

摘要

背景

使用麦金托什喉镜和麦考伊喉镜对经鼻气管插管时气管内的“导管刮擦”（即导管的气管内阻力）进行了评估。

方法

对50例需要经鼻气管插管的年轻患者进行了研究。麻醉诱导后，在使用两种喉镜之前和期间拍摄X线片。为了分析上气道的形态，我们在每张片子上绘制了三条直线[咽轴（P）、喉轴（L）和气管轴（T）]。由一名麻醉科助理医师对“导管刮擦”进行评估并分为四级。

结果

使用麦考伊喉镜的25例患者中有14例出现气管内“导管刮擦”，使用麦金托什喉镜的25例患者中有4例出现（P<0.05）。与使用麦金托什喉镜相比，使用麦考伊喉镜插管时P与L以及L与T所形成的角度减小得更多（P<0.01）。这些数据表明，使用麦考伊喉镜时P、L和T线往往无法对齐，导致气管导管无法顺利通过。