不同喉镜片对急诊经 GlideScope 视频喉镜插管成功率的影响。
The effect of stylet choice on the success rate of intubation using the GlideScope video laryngoscope in the emergency department.
机构信息
Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA.
出版信息
Acad Emerg Med. 2012 Feb;19(2):235-8. doi: 10.1111/j.1553-2712.2011.01271.x. Epub 2012 Jan 24.
OBJECTIVES
The objective was to determine whether the using the GlideRite rigid stylet (GRS) compared with a standard malleable stylet (SMS) affects the success rate of intubation using the GlideScope in emergency intubations.
METHODS
This was a retrospective analysis of prospectively collected continuous quality improvement (CQI) data based on intubations performed in an academic emergency department (ED) over a 4-year period. Following each intubation the operator completed a data form regarding multiple aspects of the intubation, including the device used, type of stylet used, procedural complications, outcome of the intubation, difficult airway predictors (DAPs), and the operator's postgraduate year (PGY). Intubation was considered successful if the GlideScope was used as the initial device and resulted in successful intubation of the trachea.
RESULTS
Over the 4-year study period, the GlideScope video laryngoscope (GVL) was used for 473 intubations. Of these, 322 (68%) used the GRS, while 151 (32%) used the SMS. When the GRS was used, operators were ultimately successful in 93.5% of cases (301 of 322), whereas when the SMS was used, operators were successful in 78.1% of cases (118 of 151; p < 0.0001). The first-attempt success rate for the GRS group was 82.9% (267 of 322) and for the SMS group was 67.5% (102 of 151; p < 0.001). The mean (± standard deviation [SD]) complication rate was 0.25 (±0.5) in the GRS group and was 0.47 (±0.7) in the SMS group (p = 0.0003). In the GRS group, 18% of patients (58 of 322) had oxygen desaturation, while in the SMS group, 31% of patients (46 of 151) had oxygen desaturation (p = 0.003). The mean number of DAPs was 2.0 (±1.5) in the GRS group and 2.0 (±1.5) in the SMS group (p = 0.65). The mean (±SD) PGY of the operator was 2.2 (±0.8) years in the GRS group and 2.2 (±0.8) years in the SMS group (p = 0.79).
CONCLUSIONS
Both first-attempt and ultimate success rates were higher with GlideScope intubations in the ED when the rigid stylet was used compared to the malleable stylet. The number of complications and, in particular, the incidence of oxygen desaturation were lower in the GRS group than in the SMS group. The two stylet groups were similar regarding difficulty of the airway and experience level of the operator.
目的
本研究旨在确定在使用 GlideRite 刚性管芯（GRS）与标准可塑管芯（SMS）进行气管插管时，使用 GlideScope 进行紧急插管的成功率是否存在差异。
方法
这是一项基于在学术急诊科（ED）进行的 4 年连续质量改进（CQI）数据的回顾性分析。在每次插管后，操作者都要填写一份数据表格，内容包括插管的多个方面，包括使用的设备、管芯类型、程序并发症、插管结果、困难气道预测因素（DAPs）以及操作者的研究生年级（PGY）。如果 GlideScope 作为初始设备使用且成功插入气管，则认为插管成功。
结果
在 4 年的研究期间，共使用 GlideScope 视频喉镜（GVL）进行了 473 次插管。其中，322 次（68%）使用了 GRS，151 次（32%）使用了 SMS。使用 GRS 时，操作者最终成功的比例为 93.5%（301/322），而使用 SMS 时，操作者成功的比例为 78.1%（118/151；p<0.0001）。GRS 组的首次尝试成功率为 82.9%（267/322），SMS 组为 67.5%（102/151；p<0.001）。GRS 组的平均（±标准差[SD]）并发症发生率为 0.25（±0.5），SMS 组为 0.47（±0.7）（p=0.0003）。GRS 组 18%的患者（58/322）出现了氧饱和度下降，而 SMS 组中 31%的患者（46/151）出现了氧饱和度下降（p=0.003）。GRS 组和 SMS 组的平均 DAP 数均为 2.0（±1.5）（p=0.65）。GRS 组和 SMS 组的平均（±SD）操作者 PGY 分别为 2.2（±0.8）年和 2.2（±0.8）年（p=0.79）。
结论
在 ED 中使用 GlideScope 进行气管插管时，与使用可塑管芯相比，使用刚性管芯的首次尝试和最终成功率均更高。GRS 组的并发症数量，尤其是氧饱和度下降的发生率低于 SMS 组。在气道难度和操作者经验水平方面，两个管芯组之间没有差异。
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