颈托固定时选择可视喉镜还是纤支镜引导气管插管？

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

可视喉镜与纤支镜在颈椎固定患者气管插管中的比较：一项随机对照试验

在颈椎固定患者中，除直接喉镜外，经常使用气管插管装置来促进气管插管并避免相关并发症。

在这项随机对照试验中，我们比较了视频喉镜和纤支镜在颈托固定患者中的气管插管。

在接受择期颈椎手术且颈部用颈托固定以模拟困难气道的患者中，使用带非通道Macintosh刀片的可视喉镜(n=166)或纤支镜镜(n=164)进行气管插管。

主要结局指标是气管插管的首次尝试成功率，次要结局指标是气管插管的总体成功率、气管插管时间、额外气道操作的使用以及气管插管相关气道并发症的发生率和严重程度。

可视喉镜组的首次插管成功率高于纤维镜组(164/166 (98.8%) vs. 149/164 (90.9%)，p=0.003)。

气管插管的中位(IQR[范围])时间更短(50.0 (41.0-72.0 [25.0-170.0]) s vs. 81.0 (65.0-107.0 [24.0-178.0]) s。

与纤支镜组相比，可视喉镜组进行额外气道操作的频率较低(30/166 (18.1%) vs. 91/164 (55.5%)，p<0.001)。

两组气管插管相关气道并发症的发生率和严重程度无差异。

当使用颈托的患者进行气管插管时，使用非通道Macintosh刀片的可视喉镜优于纤支镜。

关键词：

颈托；颈椎固定；纤支镜；气管插管；可视喉镜.

Videolaryngoscopy vs. flexible fibrescopy for tracheal intubation in patients with cervical spine immobilisation: a randomised controlled trial

In patients with cervical spine immobilisation, tracheal intubation devices other than a direct laryngoscope are frequently used to facilitate tracheal intubation and avoid related complications. In this randomised controlled trial, we compared videolaryngoscopic and fibrescopic tracheal intubation in patients with a cervical collar. Tracheal intubation was performed using either a videolaryngoscope with a non-channelled Macintosh blade (n = 166) or a flexible fibrescope (n = 164) in patients having elective cervical spine surgery whose neck was immobilised with a cervical collar to simulate a difficult airway. The primary outcome was the first attempt success rate of tracheal intubation. Secondary outcomes were the overall success rate of tracheal intubation; time to tracheal intubation; use of additional airway manoeuvres; and incidence and severity of tracheal intubation-related airway complications. First attempt success rate was higher in the videolaryngoscope group than in the fibrescope group (164/166 (98.8%) vs. 149/164 (90.9%), p = 0.003). Tracheal intubation was successful within three attempts in all patients. Median (IQR [range]) time to tracheal intubation was shorter (50.0 (41.0-72.0 [25.0-170.0]) s vs. 81.0 (65.0-107.0 [24.0-178.0]) s, p < 0.001) and additional airway manoeuvres were less frequent (30/166 (18.1%) vs. 91/164 (55.5%), p < 0.001) in the videolaryngoscope group compared with the fibrescope group. The incidence and severity of intubation-related airway complications were not different between the two groups. When performing tracheal intubation in patients with a cervical collar, videolaryngoscopy with a non-channelled Macintosh blade was superior to flexible fibrescopy.

Keywords: cervical collar; cervical spine immobilisation; flexible fibrescope; tracheal intubation; videolaryngoscope.

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本公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。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：MiLu.米鹭

校对：Michel.米萱

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