Effect of Different Shaping Angles on Endotracheal Intubation under Visual Laryngoscope for Beginners
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摘要:
目的 比较4种不同塑形角度导管对初学者气管插管成功率及术后咽部并发症的影响。 方法 选取全麻下行腹腔镜胆囊切除的患者160例，ASA分级Ⅰ～II级，无困难气道病史，根据导管形态及尖端塑形角度随机分为4组：35°蕉形弯管组（A组），50°蕉形弯管组（B组），35°直管组（C组），50°直管组（D组），每组40例。全麻诱导后，初学者采用可视喉镜进行气管插管。记录4组患者喉镜暴露分级（Cormack-Lehane分级）、喉外按压情况、插管一次成功率及插管时间；记录麻醉诱导前（T0）、麻醉诱导药物注射结束（T1）、插管即刻（T2）、插管后1min（T3）患者的SPO2、HR、MAP；随访拔管后即刻及术后24 h咽部疼痛及声音嘶哑发生率。 结果 4组患者各时间点Cormack-Lehane分级、HR、MAP比较，差异无统计学意义（P > 0.05）。B组和D组需要喉外按压的例数、插管时间、插管1次成功率、术后即刻咽痛、术后即刻声音嘶哑发生率均低于A组和C组，差异有统计学意义（P < 0.05）。 结论 使用可视喉镜进行气管插管时，50°蕉形弯管及50°直管可以缩短插管时间，术后并发症少，无明显血流动力学波动。 Abstract:Objective To compare the effects of 4 different shaping angle tubes on the success rate of tracheal intubation and postoperative pharyngeal complications among anesthetic beginners. Methods 160 patients who underwent laparoscopic cholecystectomy under general anesthesia, with ASA classification I to II, no history of difficult airway, were randomly divided into 4 groups according to the catheter shape and tip shaping angle: 35°banana-shaped elbow group（A Group）, 50°banana-shaped bent pipe group（Group B）, 35°straight pipe group（Group C）, 50°straight pipe group（Group D）, with 40 cases in each group. After induction of general anesthesia, tracheal intubation is performed using a video laryngoscope. The Cormack-Lehane grade of laryngoscope exposure, external laryngeal compression, one-time success rate of intubation and intubation time were recorded. SPO2, HR and MAP were recorded before anesthesia induction（T0）, at the end of anesthesia induction drug injection（T1）, immediately after intubation（T2） and 1min after intubation（T3）. The incidence of pharyngeal pain and hoarseness immediately after extubation and 24 hours after operation were followed up. Results There were no statistically significant differences in Cormack-Lehane classification, HR, and MAP among the four groups of patients at each time point（P > 0.05）. The number of cases requiring external laryngeal compression, intubation time, first-time intubation success rate, immediate postoperative sore throat, and immediate postoperative hoarseness rates in Groups B and D were all lower than those in Groups A and C, and the differences were statistically significant（P < 0.05）. Conclusion When using video laryngoscope for tracheal intubation, 50°banana-shaped curved tube and 50°straight tube can shorten the intubation time, reduce postoperative complications, and have no obvious hemodynamic fluctuations. -
图 1 不同气管导管塑形实物图
A：35° 蕉形弯管；B：50° 蕉形弯管；C：35° 直管；D：50° 直管。
Figure 1. Shape of different tracheal tubes
表 1 4组患者一般资料比较（n = 40）
Table 1. Comparison of the general data among the four groups of patients（n = 40）
项目 A组 B组 C组 D组 F/χ2 P 男/女（例） 22/18 16/24 18/22 22/18 2.702 0.440 年龄（岁） 43.7±10.2 46.4±10.1 44.6±12.1 44.2±11.8 0.455 0.714 BMI（kg/m2） 22.8±1.8 23.0±2.8 23.0±2.7 22.6±2.1 0.195 0.899 Mallampati分级（Ⅰ/Ⅱ） 12/28 13/27 10/30 11/29 0.610 0.894 麻醉时间（min） 90.0±21.3 85.5±22.6 86.6±24.0 89.2.±27.0 0.317 0.813 手术时间（min） 79.0±17.4 74.7±20.1 73.1±21.2 76.2±22.4 0.609 0.610 
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表 2 4组患者C-L分级、辅助喉外按压、一次插管次数、插管时间比较（n = 40）
Table 2. Comparison of CL classification，auxiliary external laryngeal compression，number of intubations at one time，and intubation time among the four groups of patients（n = 40）
项目 A组 B组 C组 D组 F/χ2 P C-L[Ⅰ/Ⅱ（n）] 8/32 4/36 5/35 7/33 1.961 0.581 辅助喉外按压[n（%）] 14（35.0） 5（12.5） 16（40.0） 3（7.5） 17.256 < 0.001* 插管时间（s） 65.6±11.4 45.5±8.7 64.8±10.1 48.1±8.4 47.389 < 0.001* 一次插管成功[n（%）] 17（42.5） 35（87.5） 15（37.5） 37（92.5） 44.396 < 0.001* *P < 0.05。
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表 3 4组患者不同时间点MAP的比较（$\bar x \pm s$，mmHg）
Table 3. Comparison of MAP at different time points among the four groups of patients （$ \bar x \pm s $，mmHg）
组别 T0 T1 T2 T3 A组（n=40） 91.1±8.0 80.5±7.9 87.3±8.1 76.2±7.8 B组（n=40） 91.1±7.5 81.7±11.9 84.8±9.7 78.2±10.2 C组（n=40） 89.9±11.1 85.0±10.5 83.6±10.1 78.8±10.3 D组（n=40） 91.4±9.8 84.6±10.2 85.5±9.0 80.1±9.2 F 1.077 1.875 1.165 1.187 P 0.361 0.136 0.325 0.317
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表 4 4组患者不同时间点的HR比较（$ \bar x \pm s $，次/min）
Table 4. Comparison of HR at different time points among the four groups of patients （$ \bar x \pm s $，times/min）
组别 T0 T1 T2 T3 A组（n=40） 72.6±9.9 72.5±6.8 83.5±8.0 73.1±7.3 B组（n=40） 72.1±12.3 74.1±10.3 83.4±7.6 69.8±7.3 C组（n=40） 74.7±11.0 76.5±9.4 85.9±8.1 72.2±10.3 D组（n=40） 75.4±10.9 75.8±9.8 84.3±9.1 75.1±10.2 F 0.841 1.511 0.668 2.428 P 0.473 0.214 0.573 0.068
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表 5 4组患者术后咽痛发生情况比较[n（%）]
Table 5. Comparison of the occurrence of postoperative sore throat among the four groups of patients [n（%）]
时间点 A组（n=40） B组（n=40） C组（n=40） D组（n=40） χ2 P 拔管后即刻咽痛 19（47.5） 6（15.0） 16（40.0） 5（12.5） 18.185 < 0.001* 拔管后24 h咽痛 4（10.0） 1（2.5） 2（5.0） 1（2.5） 3.158 0.368 拔管后即刻声音嘶哑 10（25.0） 2（5.0） 9（22.5） 3（7.5） 9.804 0.020* 拔管后即刻声音嘶哑 2（5.0） 0（0.0） 1（2.5） 1（2.5） 2.051 0.562 *P < 0.05。
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