Pernerstorfer T, Krafft P, Fitzgerald R D, Krenn C G, Chiari A, Wagner O, Weinstabl C
Department of Anaesthesia and Intensive Care Medicine, University of Vienna, Austria.
Anaesthesia. 1995 Jan;50(1):17-22. doi: 10.1111/j.1365-2044.1995.tb04506.x.
Haemodynamic and hormonal responses to tracheal intubation can be profound and associated with serious cardiovascular and cerebral side effects. The Augustine Guide, a device enabling blind oral intubation, has been introduced recently. The aim of our study was to compare the haemodynamic and hormonal stress response of this method with direct laryngoscopy. Thirty five patients (ASA 1 and 2) were randomly assigned to undergo either direct laryngoscopy (n = 17), or blind oral intubation (n = 18). Haemodynamic responses and concentrations of adrenaline, noradrenaline and prolactin were determined prior to induction, before intubation and 5 min after intubation. The median duration of intubation was 22s for direct laryngoscopy vs 46s for blind oral intubation (p < 0.05). Between the groups, no significant differences were observed for heart rate, systolic or mean arterial blood pressure. Serum levels of adrenaline decreased slightly after induction and remained unaltered after intubation in both groups. Noradrenaline (1.01 vs 0.66 nmol.l-1) and prolactin (5.2 vs 2.9 nmol.l-1) levels were significantly higher after direct laryngoscopy compared to blind oral intubation. Although blind oral intubation took significantly longer to perform than direct laryngoscopy, hormonal stress response was less pronounced. Blind oral intubation should therefore not be withheld from patients with impaired cardiovascular reserve.
气管插管引起的血流动力学和激素反应可能很强烈，并伴有严重的心血管和脑部副作用。最近推出了一种名为奥古斯丁导板的装置，可实现盲探经口插管。我们研究的目的是比较这种方法与直接喉镜检查在血流动力学和激素应激反应方面的差异。35例患者（ASA 1级和2级）被随机分配接受直接喉镜检查（n = 17）或盲探经口插管（n = 18）。在诱导前、插管前和插管后5分钟测定血流动力学反应以及肾上腺素、去甲肾上腺素和催乳素的浓度。直接喉镜检查的插管中位持续时间为22秒，而盲探经口插管为46秒（p < 0.05）。两组之间，心率、收缩压或平均动脉血压未观察到显著差异。两组患者诱导后血清肾上腺素水平略有下降，插管后保持不变。与盲探经口插管相比，直接喉镜检查后去甲肾上腺素（1.01 vs 0.66 nmol·l-1）和催乳素（5.2 vs 2.9 nmol·l-1）水平显著更高。尽管盲探经口插管的操作时间明显长于直接喉镜检查，但其激素应激反应较轻。因此，对于心血管储备功能受损的患者，不应拒绝使用盲探经口插管。
