环状软骨按压对麦金托什喉镜、麦格拉斯MAC X型叶片喉镜和GlideScope视频喉镜下喉镜视野的影响。
Effect of Cricoid Pressure on Laryngeal View During Macintosh, McGrath MAC X-Blade and GlideScope Video Laryngoscopies.
作者信息
Arslan Zehra İpek, Solak Mine
机构信息
Department of Anaesthesiology and Reanimation, Kocaeli University School of Medicine, Kocaeli, Turkey.
出版信息
Turk J Anaesthesiol Reanim. 2017 Dec;45(6):361-366. doi: 10.5152/TJAR.2017.57778. Epub 2017 Nov 29.
OBJECTIVE
Cricoid pressure is useful in fasted patients requiring emergency intubation. We compared the effect of cricoid pressure on laryngeal view during Macintosh, McGrath MAC X-Blade and GlideScope video laryngoscopy.
METHODS
After obtaining approval from the Human Research Ethics Committee and written informed consent from patients, we enrolled 120 patients (American Society of Anesthesiologists I-II, age 18-65 years) undergoing elective surgery that required endotracheal intubation in this prospective randomised study. Patients were divided into three groups (Macintosh, McGrath MAC X-Blade and GlideScope).
RESULTS
Demographic and airway variables were similar in the groups. Cormack-Lehane grades were improved or unchanged on using cricoid pressure in Macintosh and McGrath MAC X-Blade groups. However, laryngeal views worsened in 12 patients (30%), remained unchanged in 26 patients (65%) and improved in 2 patients (5%) in the GlideScope group (p<0.001). Insertion and intubation times for Macintosh and McGrath MAC X-Blade video laryngoscopes were similar. Insertion times for GlideScope and Macintosh video laryngoscopes were similar, but were longer than those for the McGrath MAC X-Blade video laryngoscope (p=0.02). Tracheal intubation took longer with the GlideScope video laryngoscope than with the other devices (p<0.001 and p=0.003). Mean arterial pressures after insertion increased significantly in Macintosh and GlideScope groups (p=0.004 and p=0.001, respectively) compared with post-induction values. Heart rates increased after insertion in all three groups compared with post-induction values (p<0.001). Need for optimisation manoeuvres and postoperative minor complications were comparable in all three groups.
CONCLUSION
Although all three devices are useful for normal or difficult intubation, cricoid pressure improved Cormack-Lehane grades of Macintosh and McGrath MAC X-Blade video laryngoscopes but statistically significantly worsened that of the GlideScope video laryngoscope.
目的
环状软骨压迫法对需要紧急插管的禁食患者有用。我们比较了环状软骨压迫法对使用麦金托什喉镜、麦格拉斯MAC X型叶片喉镜和GlideScope视频喉镜时喉镜视野的影响。
方法
在获得人类研究伦理委员会批准并征得患者书面知情同意后，我们纳入了120例（美国麻醉医师协会分级I-II级，年龄18 - 65岁）接受择期手术且需要气管插管的患者，进行这项前瞻性随机研究。患者被分为三组（麦金托什喉镜组、麦格拉斯MAC X型叶片喉镜组和GlideScope视频喉镜组）。
结果
三组患者的人口统计学和气道变量相似。在麦金托什喉镜组和麦格拉斯MAC X型叶片喉镜组中，使用环状软骨压迫法时，科马克-莱汉内分级得到改善或保持不变。然而，GlideScope视频喉镜组中有12例患者（30%）喉镜视野变差，26例患者（65%）喉镜视野不变，2例患者（5%）喉镜视野改善（p<0.001）。麦金托什喉镜和麦格拉斯MAC X型叶片视频喉镜的插入和插管时间相似。GlideScope视频喉镜和麦金托什视频喉镜的插入时间相似，但长于麦格拉斯MAC X型叶片视频喉镜的插入时间（p = 0.02）。GlideScope视频喉镜进行气管插管的时间比其他设备长（p<0.001和p = 0.003）。与诱导后相比，麦金托什喉镜组和GlideScope视频喉镜组插入后平均动脉压显著升高（分别为p = 0.004和p = 0.001）。与诱导后相比，三组患者插入后心率均升高（p<0.001）。三组患者中优化操作的需求和术后轻微并发症相当。
结论
尽管所有三种设备都可用于正常或困难插管，但环状软骨压迫法改善了麦金托什喉镜和麦格拉斯MAC X型叶片视频喉镜的科马克-莱汉内分级，但在统计学上显著恶化了GlideScope视频喉镜的分级。
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