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目的比较视可尼喉镜与普通直接喉镜在小儿全身麻醉气管插管中的应用价值、安全性和对应激反应的影响。方法选取需全身麻醉婴幼儿60例(其中新生儿16例),其中男性36例,女性24例;年龄10天~3岁,平均年龄1.1岁。随机分为2组,每组30例,其中新生儿8例,其余为1个月~3岁患儿。术前处理和麻醉诱导方法相同,Ⅰ组采用视可尼喉镜进行气管插管(经口、左侧磨牙入路),Ⅱ组则采用普通直接喉镜进行气管插管,记录各组患儿插管时间,诱导前、插管前、插管后1、3、5、10min收缩压(SBP)、舒张压(DBP)、心率(HR),计算HR与收缩压乘积(RPP)、全程监测脉搏血氧饱和度(SpO2)并于气管插管前和气管插管后5 min采动脉血检测血糖。结果Ⅰ组患儿用视可尼喉镜行气管插管时间虽略有缩短,但差异无统计学意义。血流动力学指标:组内各时点比较,两组患儿在诱导和插管时变化过程相似,诱导后至插管前HR、SBP、DBP及RPP比麻醉前明显降低(P<0.01);插管后1 min的比插管前的明显增高(P<0.01)并且达到最高,以后逐渐降低;组间比较,两组患儿在麻醉前、诱导后及插管后3、5、10 min各指标差异无统计学意义,插管后1 minⅡ组患儿的HR、SBP、DBP及RPP比Ⅰ组的明显升高,差异有统计学意义(P<0.05)。血糖:组内、组间,两组患儿插管过程中各时点之间均无明显变化(P>0.05)。全部病例SpO2无变化。Ⅰ组内有10例困难气道患儿全部一次性插管过程顺利,Ⅱ组内有8例困难气道患儿,其中5例一次性插管过程成功。两组比较,差异有统计学意义(P<0.05)。结论视可尼喉镜(儿童型)用于小儿气管插管简便易行,安全可靠,尤其对声门暴露不理想者更具优势;采用视可尼喉镜实施经口气管插管可引起与用直接喉镜气管插管相似的应激反应,但相比较轻。
Objective To compare the application value, safety and stress response of the nasal laryngoscope and general direct laryngoscope in general anesthesia pediatric intubation in children. Methods Sixty cases of infants (including 16 newborns) undergoing general anesthesia were selected. There were 36 males and 24 females, ranging in age from 10 days to 3 years with a mean age of 1.1 years. Randomly divided into two groups, 30 cases in each group, of which 8 cases of newborns, the rest for 1 month to 3 years old children. Preoperative treatment and induction of anesthesia in the same way, Ⅰ group as the endoscopic tracheal intubation (oral and left molar approach), Ⅱ group was the use of ordinary direct laryngoscope intubation, recording each group of children Intubation time, pre-induction, pre-intubation, 1,3,5,10 min after intubation systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), calculated HR and systolic blood pressure (RPP) Pulse oxygen saturation (SpO2) and blood glucose was measured before arterial intubation and 5 min after endotracheal intubation. Results In group Ⅰ, the time of endotracheal intubation with optic chiropractic was slightly shortened, but the difference was not statistically significant. The indexes of hemodynamics: At different time points, the changes of the two groups were similar during induction and intubation. HR, SBP, DBP and RPP before induction were significantly lower than those before anesthesia (P <0.01) ; 1 min after intubation was significantly higher than before intubation (P <0.01) and reached the highest, then gradually decreased; between the two groups before anesthesia, after induction and after intubation 3,5,10 min. The indexes of HR, SBP, DBP and RPP in group Ⅱ at 1 min after intubation were significantly higher than those in group Ⅰ (P <0.05). Blood glucose: intra-group, inter-group, two groups of children during intubation had no significant change between the time points (P> 0.05). SpO2 did not change in all cases. All of the 10 patients with intractable airway disease in group Ⅰ had a successful one-time intubation procedure. In group Ⅱ, there were 8 children with difficult airway disease, of which 5 had successful one-time intubation. The difference between the two groups was statistically significant (P <0.05). Conclusions The pediatric endotracheal intubation is as simple, safe and reliable as pediatric tracheal intubation, especially for patients with subglottic exposure. The use of optician laryngoscope for orotracheal intubation may lead to Similar stress responses with direct laryngoscope endotracheal intubation, but relatively light.