一项比较直接喉镜与可视喉镜插管时伤害感受水平（NOL）指数、血压和心率反应的随机对照试验：NOLint 项目。
A randomized controlled trial comparing nociception level (NOL) index, blood pressure, and heart rate responses to direct laryngoscopy versus videolaryngoscopy for intubation: the NOLint project.
机构信息
Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.
Department of Statistics, Montreal Health Innovations Coordinating Center (MHICC), Montréal, QC, Canada.
出版信息
Can J Anaesth. 2021 Jun;68(6):855-867. doi: 10.1007/s12630-021-01936-0. Epub 2021 Mar 11.
PURPOSE
The effect of direct laryngoscopy using a Macintosh blade (MAC) vs GlideScope™ videolaryngoscopy using a Spectrum LoPro blade (GVL) on nociceptive stimulation has not been quantitatively studied. This study used the new nociception level (NOL) index to compare the nociceptive response induced by GVL or MAC during laryngoscopy with or without intubation.
METHODS
Patients underwent two laryngoscopies at four-minute intervals (L1, L2), one with GVL and the other with MAC (first randomization). A third laryngoscopy (L3) followed by tracheal intubation was performed four minutes after L2 (GVL or MAC, second randomization). Nociception was quantitatively assessed by NOL and standard hemodynamic parameters (heart rate [HR] and mean arterial pressure). For the crossover design, blade comparisons accounted for sequence and blade type. A possible carryover effect between laryngoscopies was assessed.
RESULTS
In the 50 patients randomized, there was no carryover effect from one laryngoscopy to the next for all analyzed parameters. Nociception level index peak values were higher with MAC than GVL. Analysis of ΔNOL showed a lower nociceptive response with GVL for L1+L2 combined. Mean peak NOL values were significantly higher after L3+intubation than after L1+L2, for both GVL and MAC groups. Analysis of ΔHR values did not show a significant difference between GVL and MAC for any laryngoscopy.
CONCLUSION
Laryngoscopy alone with GVL induces less nociception than with MAC. The NOL was more sensitive than HR at detecting nociceptive responses to MAC vs GVL. Additionally, and irrespective of which technique/blade was used, the combination of laryngoscopy + tracheal intubation produced a much greater nociceptive response than the laryngoscopy alone.
TRIAL REGISTRATION
www.clinicaltrials.gov (NCT03277872); registered 29 August 2017.
目的
尚未对直接喉镜使用 Macintosh 叶片（MAC）与 GlideScope™视频喉镜使用 Spectrum LoPro 叶片（GVL）对伤害性刺激的影响进行定量研究。本研究使用新的伤害感受水平（NOL）指数比较了 GVL 或 MAC 行喉镜检查时（有或无插管）引起的伤害性反应。
方法
患者在 4 分钟的间隔内接受两次喉镜检查（L1、L2），一次使用 GVL，另一次使用 MAC（第一次随机分组）。在 L2 后 4 分钟进行第三次喉镜检查（L3）并进行气管插管（GVL 或 MAC，第二次随机分组）。通过 NOL 和标准血流动力学参数（心率[HR]和平均动脉压）对伤害感受进行定量评估。对于交叉设计，叶片比较考虑了序列和叶片类型。评估了两次喉镜检查之间是否存在潜在的延续效应。
结果
在 50 名随机分组的患者中，对于所有分析参数，从一次喉镜检查到下一次喉镜检查均无延续效应。MAC 时的 NOL 指数峰值高于 GVL。分析 ΔNOL 显示，L1+L2 联合时 GVL 的伤害性反应较低。对于 GVL 和 MAC 组，L3+插管后的平均峰值 NOL 值均明显高于 L1+L2。对于任何喉镜检查，HR 值的分析均未显示 GVL 和 MAC 之间存在显著差异。
结论
与 MAC 相比，单独使用 GVL 进行喉镜检查引起的伤害感受较少。与 HR 相比，NOL 更能敏感地检测到 MAC 与 GVL 之间的伤害性反应。此外，无论使用哪种技术/叶片，喉镜检查+气管插管的组合比单独喉镜检查引起的伤害性反应大得多。
试验注册
www.clinicaltrials.gov（NCT03277872）；2017 年 8 月 29 日注册。
Zotero 插件