沈佳洋　杨清春　高海鹰　王庆祥　萧燕芳　林瑾　蒋晟　冯宇峰

【摘要】 目的：探討麻醉规培医师应用视频喉镜（video-laryngoscopy，VL）在喉头显露Ⅲ、Ⅳ级的全麻患者行气管插管的效果及插管教学中的作用。方法：选取2017年1月-2019年12月于本院直接喉镜（direct laryngoscopy，DL）暴露声门Cormack-Lehane显示Ⅲ、Ⅳ级的80例手术患者，按照随机数字表法分为VL组和DL组，各40例。分别由熟练运用两种喉镜的麻醉规培医师进行气管插管，VL组在视频喉镜下实施气管插管，插管2次失败由指导老师插管;DL组在直接喉镜下实施气管插管2次失败，则改为视频喉镜下气管插管。比较两组总插管成功率、插管成功者的插管时间、首次插管成功率及咽喉黏膜损伤出血、咽痛、声嘶等并发症的发生率。结果：VL组总插管成功率高于DL组，插管成功者插管时间短于DL组，首次插管成功率明显高于DL组，咽喉黏膜损伤出血、咽痛、声嘶的发生率均低于DL组，差异均有统计学意义（P<0.05）。结论：在麻醉教学中，麻醉规范化培训住院医师将视频喉镜用于喉头显露Ⅲ、Ⅳ级患者气道管理效果明显，气管插管用时短，成功率高，伴随并发症少;VL对气管插管教学具有指导作用。

【关键词】 麻醉 规范化培训 住院医师 视频喉镜 教学 气管插管 困难气道

[Abstract] Objective： To investigate the effect of standardized training anesthetic residents doctor used video-laryngoscopy （VL） for endotracheal intubation in the patients with larynx exposure Ⅲ， Ⅳ grade and grade general anesthesia and the role of intubation teaching. Method： From January 2017 to December 2019 in our hospital 80 surgical patients direct laryngoscopy （DL） exposed the glottis Cormack-Lehane display Ⅲ， Ⅳ grade were selected， according to random number table method， they were divided into VL and DL group， 40 cases in each group. Tracheal intubation was performed by anesthesiologists who were skilled in using the two kinds of laryngoscope， tracheal intubation was performed under video laryngoscope in the VL group， if the intubation failed twice， the instructor intubated the tube; in the DL group， tracheal intubation under direct laryngoscope failed for 2 times， so it was changed to tracheal intubation under video laryngoscope. The total success rates of intubation， intubation time，  the success rate with first intubation and the incidence of complications such as pharyngeal mucosa injury and bleeding， pharyngalgia， hoarseness of patients with successful intubation were compared between the two groups. Result： The total success rate of intubation in the VL group was higher than that in the DL group， the duration of intubation of patients with successful intubation in the VL group was shorter than that in the DL group， the success rate of first intubation was significantly higher than that in the DL group， the incidence of bleeding of laryngopharyngeal mucosa injury， sore throat and hoarseness were lower than those in the DL group， the differences were statistically significant （P<0.05）. Conclusion： In anesthesiology teaching， standardized training anesthetic residents doctor use VL for the airway management of patients with larynx exposure Ⅲ， Ⅳ grade， with short time of endotracheal intubation， high success rate and fewer accompanying complications. VL plays a guiding role in endotracheal intubation teaching.

[Key words] Anesthesia Standardized training Resident doctor Video laryngoscopy Teaching Endotracheal intubation Difficult airway

First-authors address： The First Affiliated Hospital of Xiamen University Fujian， Province Anesthesiology Department Resident Doctor Standardization Training Base， Xiamen 361003， China

doi：10.3969/j.issn.1674-4985.2021.11.042

近年來随着麻醉设备的更新换代，麻醉技术水平亦不断提高。气管插管全麻的临床应用愈发广泛，但高达3%的困难气管插管发生率却是临床麻醉医师棘手状况[1]。对于已经明确预先知晓存在困难气道的患者，宜采用给予患者表面麻醉加适当镇静镇痛，保留自主呼吸清醒状态下完成气管内插管。在过去的10年中，视频喉镜（video-laryngoscopy，VL）在管理预期的困难气道方面的普及程度已经大大提高[2]。对于未预知的困难气道患者，应用VL能够相对更容易显露声门，从而利于提高困难气道患者的气管内插管成功率[3-4]。……