评价光棒引导气管插管在无牙或缺牙患者中的应用：一项随机对照研究。

Evaluation of lightwand-guided endotracheal intubation for patients with missing or no teeth: a randomized controlled study.

机构信息

Anhui Medical University, The First Affiliated Hospital, Department of Anesthesiology, Hefei, China; Bozhou People's Hospital, Department of Anesthesiology, Bozhou, China.

Bozhou People's Hospital, Department of Anesthesiology, Bozhou, China.

出版信息

Braz J Anesthesiol. 2021 Jul-Aug;71(4):395-401. doi: 10.1016/j.bjane.2021.03.002. Epub 2021 Apr 8.

DOI:10.1016/j.bjane.2021.03.002

PMID:33839178

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9373093/

Abstract

BACKGROUND

Unhealthy teeth can seriously affect general health and increase the risk of death in elderly people. There has been no confirmation of which device is most effective for elderly patients with teeth loss. Therefore, we compared four intubation devices in elderly patients with partial and total tooth loss aiming to reduce risk during anesthesia.

METHODS

Two hundred patients were randomized to undergo tracheal intubation with the Macintosh laryngoscope, the Glidescope, the Fiberoptic bronchoscope or the Lightwand as part of general anesthesia. A unified protocol of anesthetic medications was used. HR and BP were measured at T, T, T, T, T and T. Catecholamine (epinephrine and norepinephrine) blood samples were drawn at T, T and T. Intubation time and postoperative complications, including dental damage and losses, were recorded.

RESULTS

Reduced fluctuations in HR, DBP, and SBP were observed in the Lightwand group. Intubation time was significantly shorter in the Lightwand group (p < 0.05). There was no statistically significant difference between the groups in epinephrine levels, but norepinephrine levels were less volatile in the Fiberoptic bronchoscope and Lightwand groups. Fewer patients in the Lightwand group experienced dental damage and other postoperative complications than in the other three groups. Although a higher success rate on the first attempt was as high as in the Fiberoptic bronchoscope group, shorter intubation time was observed only in the Lightwand group.

CONCLUSION

The Lightwand offers less hemodynamic stimulation than the Macintosh laryngoscope, Glidescope, and Fiberoptic bronchoscope. Because it had the shortest intubation time, the Lightwand caused the least damage to the teeth and throat of elderly patients. Our findings showed that tracheal intubation with the Lightwand was advantageous for preventing cardiovascular stress responses with short intubation times and fewer postoperative complications.

摘要

背景

不健康的牙齿会严重影响整体健康，并增加老年人死亡的风险。目前还没有确定哪种设备对缺失牙齿的老年患者最有效。因此，我们比较了四种插管设备在部分和全牙缺失的老年患者中的效果，旨在降低麻醉过程中的风险。

方法

200 名患者随机分为使用 Macintosh 喉镜、Glidescope、纤维支气管镜或 Lightwand 进行气管插管的四组，所有患者均接受全身麻醉。使用统一的麻醉药物方案。在 T、T、T、T、T 和 T 时测量 HR 和 BP。在 T、T 和 T 时抽取儿茶酚胺（肾上腺素和去甲肾上腺素）血样。记录插管时间和术后并发症，包括牙齿损伤和丢失。

结果

Lightwand 组的 HR、DBP 和 SBP 波动减少。Lightwand 组的插管时间明显缩短（p<0.05）。各组之间肾上腺素水平无统计学差异，但纤维支气管镜和 Lightwand 组的去甲肾上腺素水平波动较小。Lightwand 组的牙齿损伤和其他术后并发症发生率低于其他三组。虽然首次尝试的成功率与纤维支气管镜组一样高，但只有 Lightwand 组观察到插管时间更短。

结论

Lightwand 对血流动力学的刺激小于 Macintosh 喉镜、Glidescope 和纤维支气管镜。由于插管时间最短，Lightwand 对老年患者的牙齿和喉咙造成的损伤最小。我们的研究结果表明，Lightwand 进行气管插管有利于预防心血管应激反应，同时具有较短的插管时间和较少的术后并发症。