头颈部位置对气管插管的影响

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

头颈部位置对使用McGRATH MAC视频喉镜进行气管插管的影响：

一项随机前瞻性研究

背景

不同的头颈部位置可能会影响视频喉镜检查，包括喉部暴露、插管困难、气管导管进入声门以及腭咽粘膜损伤的发生。

目的

我们使用McGRATH MAC视频喉镜研究了简单的头部伸展、无头部伸展的头部抬高和嗅探位置对气管插管的影响。

设计

一项随机前瞻性研究。

场所

大学附属三级医疗中心。

患者

共有174名患者接受全身麻醉。

方法

患者被随机分配到三组中的一组：单纯的头部伸展（无枕头的颈部伸展）、仅头部抬高（有7厘米枕头的头部抬高，无颈部伸展）和嗅物位置（有7 cm枕头的头部抬起，颈部伸展）。

主要结局指标

在三种不同的头颈部位置使用McGRATH MAC视频喉镜进行气管插管期间，我们通过几种方法评估插管难度：

改良插管难度量表评分、

气管插管所需时间、

声门打开、

插管尝试次数，

喉部暴露

和气管导管进入声门的其他操作（升力或喉部压力）的要求。

气管插管后评估腭咽粘膜损伤的发生情况。

结果

仅头部抬高组的气管插管明显比单纯头部伸展组（P=0.001）和嗅物位置组（P=0.011）容易。

单纯头部伸展和嗅探姿势组的插管难度没有显著差异（P=0.052）。

仅头部抬高组插管所需时间明显短于单纯头部伸展组（P＜0.001）。

与单纯头部伸展组（P＝0.002）和嗅探位置组（P＞0.012）相比，仅头部抬高组导管进入声门所需的力或压喉频率较嗅物位置低（P=0.498）。

头抬高组的腭咽粘膜损伤发生率低于单纯伸头组（P=0.009）。

结论

与简单的头部伸展或嗅物位置相比，头部抬高位置有助于使用McGRATH MAC视频喉镜进行气管插管。

原文摘要

Effect of head and neck positions on tracheal intubation using a McGRATH MAC video laryngoscope A randomised, prospective study

BACKGROUND 

Different head and neck positions may affect video laryngoscopy in terms of laryngeal exposure, intubation difficulty, advancement of the tracheal tube into the glottis and the occurrence of palatopharyngeal mucosal injury.

OBJECTIVE 

We investigated the effects of simple head extension, head elevation without head extension and the sniffing position on tracheal intubation using a McGRATH MAC video laryngoscope.

DESIGN 

A randomised, prospective study.

SETTING 

Medical centre governed by a university tertiary hospital.

PATIENTS 

A total of 174 patients undergoing general anaesthesia.

METHODS 

Patients were randomly allocated to one of three groups: simple head extension (neck extension without a pillow), head elevation only (head elevation with a pillow of 7 cm and no neck extension) and sniffing position (head elevation with a pillow of 7 cm and neck extension).

MAIN OUTCOMES 

During tracheal intubation using a McGRATH MAC video laryngoscope in three different head and neck positions, we assessed intubation difficulty by several methods: a modified intubation difficulty scale score, time taken for tracheal intubation, glottic opening, number of intubation attempts, requirements for other manoeuvres (lifting force or laryngeal pressure) for laryngeal exposure and advancement of the tracheal tube into the glottis. The occurrence of palatopharyngeal mucosal injury was evaluated after tracheal intubation.

RESULTS 

Tracheal intubation was significantly easier in the head elevation group than in the simple head extension (P = 0.001) and sniffing positions (P = 0.011). Intubation difficulty did not differ significantly between the simple head extension and sniffing positions (P = 0.252). The time taken for intubation in the head elevation group was significantly shorter than that in the simple head extension group (P < 0.001). A lifting force or laryngeal pressure was required less frequently for tube advancement into the glottis in the head elevation group than in the simple head extension (P = 0.002) and sniffing position groups (P = 0.012). The need for a lifting force or laryngeal pressure for tube advancement into the glottis was not significantly different between the simple head extension and sniffing positions (P = 0.498). Palatopharyngeal mucosal injury occurred less frequently in the head elevation group than in the simple head extension group (P = 0.009).

CONCLUSION 

The head elevation position facilitated tracheal intubation using a McGRATH MAC video laryngoscope compared with a simple head extension or sniffing position.

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：Michel.米萱

校对：MiLu.米鹭

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