孙波 高静 边步荣 高彦东 陈宇

[摘要] 目的 观察Airtraq喉镜用于颈椎手术合并困难气道患者气管插管的效果。 方法 选择2014年7月～2015年7月于我院择期行颈椎手术的患者80例，随机将其分为A组（Airtraq喉镜）和B组（普通喉镜），每组40例。静脉麻醉诱导后，两组分别在Airtraq喉镜、普通喉镜引导下经口行气管插管。记录两组患者麻醉诱导前、气管插管即刻和插管后1、2、3 min的平均动脉压（MAP）、心率（HR）及（BIS）值，以及两组喉镜下声门显露情况、插管时间、一次插管成功率和插管总成功率等。 结果 喉镜下声门显露A组患者均为Ⅰ级，B组患者有14例为Ⅰ级，12例为Ⅱ级，9例为Ⅲ级，5例为Ⅳ级。A组插管时间（10.5±6.2）s，明显短于B组的（75.3±4.1）s（P<0.05）。A组插管即刻MAP、HR及BIS值均显著低于B组（P<0.05）；插管后2、3 min MAP和HR均显著低于B组（P<0.05），BIS值差异无统计学意义（P>0.05）。A组所有病例均未行喉部外压动作，B组行喉部外压动作8例，差异有统计学意义（P<0.05）。A组总成功40例，均一次插管成功；B组总成功36例，其中一次插管成功34例，三次插管成功2例，4例因3次插管后仍未能显露声门，改用纤支镜完成插管，A组一次插管成功率和插管总成功率均明显高于B组（P<0.05）。 结论 Airtraq喉镜用于颈椎活动受限患者气管插管，视野清晰、暴露好，插管迅速，对患者血流动力学影响小，且成功率高、损伤小。

[关键词] Airtraq喉镜；颈椎手术；困难气道；颈椎活动受限

[中图分类号] R614 [文献标识码] A [文章编号] 1674-4721（2016）02（b）-0104-03

Clinical study of Airtraq laryngoscope on trachea cannula in patients with limited move of cervical vertebra

SUN Bo GAO Jing BIAN Bu-rong GAO Yan-dong CHEN Yu

Department of Anesthesiology，the Second Affiliated Hospital of Medical College in Yan′an University，Shaanxi Province，Yulin 719000，China

[Abstract] Objective To observe the effect of Airtraq laryngoscope on trachea cannula in patients with cervical vertebrasurgery combining withdifficult airway. Methods From July 2014 to July 2015，80 patients undergone cervical vertebra surgery in our hospital were selected and evenly divided into group A （Airtraq laryngoscope） and group B （common laryngoscope） in random.After intravenous anesthetic induction，tracheal intubation via mouth was implemented under the guidance of Airtraq laryngoscope and common laryngoscope respectively.The values of mean arterial pressure （MAP），heart rate （HR），and bispectralindex （BIS） before induction of anesthesia，during instant intubation，and 1，2，3 min after intubation in both groups were recorded as well as glottis exposure under laryngoscope，intubation time，one-time success rate of intubation and total success rate of intubation. Results In the two groups，glottis exposure in group A was in Ⅰ classification ，while in group B，the number of classifications in Ⅰ，Ⅱ，Ⅲ and Ⅳwas 14，12，9 and 5 cases in turn.The intubation time in group A was （10.5±6.2） s，much shorter than that in group B of （75.3±4.1） s （P<0.05）.The values of MAP，HR，and BIS in instant intubation in group A were all greatly lower than those in group B （P<0.05）.Values of MAP and HR 2，3 min after intubation in group A were obviously lower than those in group B （P<0.05），but on significant difference in BIS value （P>0.05）.In group A，no case was performed with laryngeal external pressure，while in group B，8 patients needed，which displayed a statistical difference.In group A，40 cases of tracheal intubations were all successful only in once.In group B，the number of total success was 36 cases，and one-time success of intubation was 34 cases，2 cases were successful after 3 times of intubation，the rest 4 cases due to no exposure of glottis after 3 times of intubation were switched to bronchofiberscope.The success rate of one-time intubation and total successful rate of intubation in group A were both higher in comparison with those in group B （P<0.05）. Conclusion Airtraq laryngoscope for intubation in patients with limited move of cervical vertebra has advantages of clear vision，good exposure，rapid intubation，little influence on hemodynamics，high success rate，and mild injury.

[Key words]Airtraq laryngoscope；Cervical vertebra surgery；Difficult airway；Limited move of cervical vertebra

颈椎手术伴有活动受限的患者在全身麻醉气管插管时会形成困难气道，使用普通喉镜直视下行气管插管时搬动头部易造成颈椎的再次损伤，因此在麻醉前必须对患者的气道进行正确的评估，制订合适的插管方案。Airtraq喉镜是一种新型气道管理工具，它是根据口咽部解剖结构设计而成，是一种较易掌握的直观插管工具。本研究将Airtraq喉镜用于行颈椎手术并活动受限患者的气管插管中，观察其有效性和安全性。

1资料与方法

1.1一般资料

选择2014年7月～2015年7月入住我院骨科择期行颈椎手术并活动受限的患者80例，ASAⅠ～Ⅱ级，其中男36例，女44例，年龄35～57岁，体重57～80 kg，随机将其分为A组和B组，每组40例，术前无高血压病史及呼吸系统疾病。……