Heath K J
Cambridge Military Hospital, Aldershot, Hants.
Anaesthesia. 1994 Oct;49(10):843-5. doi: 10.1111/j.1365-2044.1994.tb04254.x.
Fifty patients underwent laryngoscopy with two different cervical spine immobilisation techniques. First the cervical spine was immobilised in a rigid collar with tape across the forehead and sandbags on either side of the neck, then with an assistant providing manual in-line immobilisation. Finally, patients underwent laryngoscopy in the routine intubating position. In 56% of patients the view of the larynx improved by one grade and in 10% the view improved by two grades when manual immobilisation was substituted for the collar, tape and sandbags (p < 0.0001). There was a poor view on laryngoscopy (grade 3 or 4) in 64% of patients when immobilised in a collar, tape and sandbags compared to 22% of patients undergoing in-line manual immobilisation (p < 0.001). Mouth opening was significantly reduced when patients were wearing cervical collars and this was the main factor contributing to the increased difficulty of laryngoscopy in this particular form of cervical spine immobilisation. It is recommended that manual in-line immobilisation should be the method of choice for cervical spine stabilisation during tracheal intubation.
五十名患者接受了喉镜检查，采用了两种不同的颈椎固定技术。首先，颈椎用硬领固定，并用胶带横跨前额，在颈部两侧放置沙袋，然后由一名助手进行手动轴向固定。最后，患者在常规插管体位下接受喉镜检查。当用手动固定取代硬领、胶带和沙袋时，56%的患者喉镜视野改善了一个等级，10%的患者视野改善了两个等级（p<0.0001）。与接受轴向手动固定的22%的患者相比，64%用硬领、胶带和沙袋固定的患者喉镜检查视野不佳（3级或4级）（p<0.001）。患者佩戴颈托时，张口明显减小，这是这种特定形式的颈椎固定导致喉镜检查难度增加的主要因素。建议在气管插管期间，手动轴向固定应作为颈椎稳定的首选方法。
