Cookgas和Fastrach气管插管型喉罩用于预测困难气管插管的比较

摘要

目的 比较Cookgas气管插管型喉罩(CILA)和Fastrach气管插管型喉罩(FT-LMA)在预测困难气管插管处理中使用盲探插管技术的临床效果.方法 择期在全身麻醉下行整形外科手术的预测困难气管插管患者86例,采用Excel软件随机分为CILA组(n=43)和FT-LMA组(n=43).麻醉诱导后,分别置入CILA或FT-LMA,经CILA或FT-LMA直接盲探气管插管,记录CILA和FT-LMA置入次数和时间、盲探气管插管次数和时间、喉罩拔除时间,以及在实施盲探气管插管前经喉罩插入纤维光导支气管镜(FOB)镜下声门暴露情况,并记录麻醉诱导前、后,喉罩插入后即刻、气管插管后即刻、拔除喉罩后即刻以及插管后5 min内的血压和心率变化.结果 两组86例患者均成功置入CILA或FT-LMA,首次置入成功率差异无统计学意义(P＞0.05).CILA组35例首次气管插管成功,5和2例分别在第2、3次成功插管,1例插管失败,改用FOB经CILA引导插管;FT-LMA组32例1次插管成功,4例2次成功,3例3次成功,4例失败,其中3例改用FOB经FT-LMA引导插管,1例由FOB引导完成插管.与CILA组比较,FT-LMA组喉罩置入时间[(22.4±18.9)s 比(34.2±13.9)s] 显著延长(P＜0.05),而经CILA和FT-LMA引导盲探气管插管时间[(46.0±26.7)s 比(51.8±41.1)s]及喉罩退出时间[(39.3±11.9)s 比(35.3±10.4)s]差异无统计学意义(P＞0.05).气管插管对两组患者血流动力学影响差异无统计学意义(P＞0.05).结论 经CILA和FT-LMA盲探气管插管均可安全有效地应用于预测困难气管插管患者,但CILA置入更容易,盲探气管插管成功率更高.%Objective To compare the clinical effectiveness of blind intubation through the Cookgas in-tubating laryngeal airway (CILA) or Fastrach intubating laryngeal mask airway (FT-LMA) for anticipated difficult tracheal intubation. Methods Eighty- six patients with anticipated difficult tracheal intubation who were undergoing elective plastic surgery under general anesthesia were randomly allocated into CILA group (n = 43 ) and FT-LMA group ( n =43) . After general anesthesia being induced and CILA or FT-LMA being inserted, the patients were treated with blind intubation through CILA or FT-LMA. In each case, the number and the time of intubating laryngeal airway (ILA) insertion and blind intubation attempts and ILA removal were recorded. The view of glottis under fiberoptic bronchoscope (FOB) via CILA or FT-LMA was recorded. In addition, noninva-sive blood pressure and heart rate were recorded before and after intravenous anesthetic induction, at ILA insertion , at intubation, at ILA removal and every minute thereafter for 5 minutes. Results CILA or FT- LMA was inserted successfully in all 86 patients. The rate of the first successful insertion was not significantly different between two groups (P > 0. 05 ) . In CILA group, the first intubation attempt succeeded in 35 patients; 5 and 2 cases were intubated blindly at the second and the third attempt, one patient failed who was intubated successfully by FOB via CILA. In FT-LMA group, 32 patients were intubated successfully at the first attempt, 4 at the second attempt, 3 at the third attempt, and 4 cases failed, three of them were intubated smoothly with FOB through FT-LMA, one failed patient was intubated by FOB. The time of FT-LMA insertion (34. 2 ± 13. 9) s was significantly longer when compared with CILA (22. 4 ± 18. 9 ) s ( P < 0. 05 ). However, the time of blind intubation through CILA and FT-LMA [(46.0 ±26. 7) s vs. (51. 8 ±41. 1) s] and the time of ILA removal [(39. 3 ±11. 9) s vs. (35. 3 ±10.4) s] were not significantly different between groups (P>0. 05). Hemodynamic changes during blind intubation in the two groups showed no significant differences (P > 0. 05 ) . Conclusions Blind intubation via CILA or FT-LMA is safe and effective for anticipated difficult tracheal intubation. Nevertheless, CILA is easier to be inserted, with relatively higher success rate of blind intubation.