摘要
目的 观察插管过程中采用帝视观察用内窥镜（disposcope endoscope,DE）与Macintosh喉镜（mcintosh laryngoscope,ML）对上颈椎活动度的影响.方法 36例术前评估可能存在声门暴露困难的患者,年龄30～60岁,ASAⅡ或Ⅲ级.在确保无面罩通气障碍的情况下进行麻醉诱导,诱导后分别应用DE和ML插管进行声门暴露,测量暴露前后C1与枕骨,C1～C4各相邻椎体之间的角度变化.结果 ML暴露时上颈椎累计活动度的中位数为35.5°,DE暴露时上颈椎累计活动度的中位数为18.9°（P＜0.01）.ML暴露时相邻颈椎活动度的中位数分别为8.4°、23.7°、3°、1°,与暴露前比较,相邻椎体间角度变化分别为13.5°、8.0°、6.1°和1°;而DE暴露时相邻颈椎活动度的中位数为4°、14°、-3.5°、2°,与暴露前比较,相邻椎体间角度变化分别为9.1°、1.7°、0.4°和0°,采用DE方法活动度明显小于采用ML方法（P＜0.01）.结论 在插管过程中DE能更好地维持上颈椎的稳定性.
Objective To observe the effects of Disposcope endoscope （DE） and the Macintosh laryngoscope （ML） on the active degree of upper cervical vertebrae in the procedure of anesthesia intubation.Methods Thirty-six patients who were 30-60 y,ASA Ⅰ or Ⅱ suspected to have limited views of the glottis but no ventilation difficulty were enrolled.All patients underwent the glottic exposure with DE and ML after anesthesia induction.Maximum changes of the angles between C1 and occipital bone,and adjacent cervical vertebraes from C1 to C4 were measured before and after the glottis exposure.Results The median of cumulative upper C-spine movement angles was 35.5° when the ML was used while was 18.9° when the DE was used （P〈0.01）.The medians （occiput-C1：4°,C1-C2：14°,C2-C3：-3.5°,C3-C4：2°） and angle changes （oeeiput-C1：9.1°,C1-C2：1.7°,C2-C3：0.4°,C3-C4：0°） between the adjacent cervical vertebraes in patients using the DE were significantly decreased when compared with the medians （occiput-C1：8.4°,C1-C2：23.7°,C2-C3：3°,C3-C4：1°） and angle changes （occiput-C1：13.5°,C1-C2：8.0°,C2-C3：6.1°,C3-C4 1°） in patients using the ML （P 〈0.01）.Conclusion Compared with the ML,the DE appears to be a promising means in maintaining the cervical spine stability.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2014年第1期43-45,共3页
Journal of Clinical Anesthesiology
