徐永生,趙 磊,高 楠

(佳木斯大學(xué)附屬第一醫(yī)院麻醉科,黑龍江佳木斯 154003)

依據(jù)近年來氣管插管臨床研究成果分析,各種新式的視頻喉鏡可能會優(yōu)于傳統(tǒng)喉鏡,尤其是在處理困難氣道方面[1]。我們介紹 1例應(yīng)用 McGrathw視頻喉鏡用于嚴(yán)重強(qiáng)直性脊柱炎病人清醒下插管患者?；颊?男 ,75歲,不慎跌倒,脊柱 CT提示 L2壓縮性骨折,需外科手術(shù)治療;既往嚴(yán)重強(qiáng)直性脊柱炎病史;經(jīng)氣道評估后(見表1),計(jì)劃應(yīng)用 McGrathw視頻喉鏡清醒下插管 ,首先,分兩次將 10mg利多卡因用噴霧器對舌咽和喉咽噴霧,6min后應(yīng)用 McGrathw視頻喉鏡行氣管插管,一次成功,未見任何并發(fā)癥。觀察發(fā)現(xiàn)聲門 Cormack-Lehane評分為 2級。

表1 患者氣道評估

討論:對于強(qiáng)直性脊柱炎患者,常表現(xiàn)為頸部僵硬和張口受限,在應(yīng)用常規(guī)喉鏡進(jìn)行氣管插管時(shí)很困難,因此,這種情況下通常使用視頻喉鏡。以往的研究表明,使用視頻喉鏡插管對于困難氣道可能優(yōu)于常規(guī)喉鏡[2,3]。McGrathw視頻喉鏡和 Airway Scopew已成功的用于頸椎病和常規(guī)喉鏡插管失敗的患者[4]。在一項(xiàng)隨機(jī)研究中 ,60例上呼吸道腫瘤患者應(yīng)用 GlideScopew和 Airtraq進(jìn)行比較,應(yīng)用 GlideScopew插管的成功率為 100%,Airtraq組成功率占 93%[5]。20例強(qiáng)直性脊柱炎患者中,有 17例使用 GlideScopew經(jīng)鼻插管獲得成功。在 30例常規(guī)喉鏡失敗或欠佳的情況下,使用 McGrathw視頻喉鏡 25例插管成功,3例置管失敗,2例喉鏡檢查失敗[6]。大樣本(150例)研究發(fā)現(xiàn),應(yīng)用 McGrathw喉鏡氣管插管成功率為 98%[7]。一般認(rèn)為,與傳統(tǒng)喉鏡相比,應(yīng)用視頻喉鏡頻繁插管時(shí)所引起的損傷少。Copper[8]報(bào)道兩例與喉鏡檢查有關(guān)的腭咽弓受傷,GL和 O'Leary[6]報(bào)道 4例 McGrathw視頻喉鏡插管期間引起局部輕微出血?？傊?使用 McGrathw視頻喉鏡為嚴(yán)重的強(qiáng)直性脊柱炎患者清醒氣管插管,簡單易學(xué),可操作性強(qiáng)。

[1] Martin F,Bugg y DJ.New airway equipment:opportunities for enhanced safety[J].Br J Anaesth,2009,102:734-738

[2] ShippeyB, RayD, McKeown D. Use of the McGrath videolaryngoscope in the management of difficult and failed tracheal intubation[J].Br J Anaesth,2008,100:11

[3] Lai HY,Chen IH,Chen AF,et al.The use of the Glide Scope for tracheal intubation in patients with ankylosing spondylitis[J].Br J Anaesth,2006,97:419-422

[4] Liu EHC,Poon KH,Ng BSW,et al.Airway Scope,a new video laryngoscope:its use in three patients with cervical spine problems[J].Br J Anaesth,2008,100:142-43

[5] Lange M,Frommer M,Redel A,et al. Comparison of the Glide Scopew and Airtraqw optical laryngoscopes in patients under- going direct microlaryngoscopy[J].Anaesthesia,2009,64:323-328

[6] O'Leary AM, Sandison MR,Myneni N,et al.Preliminary evaluation of a novel videolaryngoscope,the McGrath series 5,in the management of difficult and challen-ging endotracheal intubation[J].J Clin Anaesth,2008,20:320-321

[7] Shippey B,Ray D,McKeown D.Caseseries:the McGrathw videolaryn- goscope-an initial clinical evaluation[J].Can J Anaesth,2007,54:307-313

[8] Copper RM.Complications associated with the use of the Glide Scopew videolaryngoscope[J].Can J Anaesth,2007,54:54-57