随机比较使用GlideScope可视喉镜与Magill镊子或与血管钳对正常气道患者进行经鼻插管时的有效性。
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Randomized comparison of the effectiveness of nasal intubation using a GlideScope video laryngoscope with Magill forceps versus vascular forceps in patients with a normal airway.
背景与目的
GlideScope视频喉镜（GVL）广泛应用于口腔颌面部整形手术时的气管插管。Magill镊子的角度与GVL镜片的角度不同，这表明Magill镊子不是联合用于GVL的理想镊子。 本研究的目的是比较使用GVL进行经鼻气管插管时Magill镊子与血管钳的有效性。
方 法
本研究共纳入60例需要经鼻气管插管的择期手术患者。通过计算机分配，患者被随机分配到两组中的一组，即Magill镊子组（M组）或血管钳配以管交换器（组V）。 主要结局指标是总插管时间，即从麻醉医师拿起装置到插管后读出三个连续的呼气末CO 2波时的时间。 次要结局指标是经鼻气管插管时的出血情况和口腔组织或牙齿的损伤情况。盲法观察并评估患者在手术后1小时和24小时咽喉部的疼痛情况。
结 果
M组和V组之间的总插管时间有显着差异（96.1秒和78.1秒，平均差异18秒，95％置信区间（CI），13.7-49.7）；M组中鼻出血发生率明显高于V组（46.7%vs 16.7％，相对危险度为2.8，95％CI，1.2-6.8）。
结 论
血管钳（和管交换器）的总插管时间显着小于Magill镊子。 与使用Magill镊子相比，使用血管钳也降低鼻出血的发生率。 当使用GlideScope视频喉镜用于鼻气管插管时，使用管交换器和血管钳更优于使用Magill镊子。
原始文献摘要
Jong H, Mi K,. Woo J,et al.Randomized comparison of the effectiveness of nasal intubation using a GlideScope video laryngoscope with Magill forceps versus vascular forceps in patients with a normal airway.Can J Anesth.26 August 2017.DOI 10.1007/s12630-017-0971-4.
Purpose The GlideScope video laryngoscope (GVL) is widely used for nasotracheal intubation in dental and facial plastic surgery. The angle of the Magill forceps is different from that of the GVL blade, which suggests that the Magill forceps are not the ideal forceps for use with the GVL. The purpose of this study was to compare the effectiveness of the Magill forceps vs vascular forceps for nasotracheal intubation using the GVL.
Methods This study included 60 patients scheduled to undergo elective surgery requiring nasotracheal intubation. Patients were assigned to one of two groups—i.e., Magill forceps (group M) or vascular forceps along with a tube exchanger (group V), by computer randomization. The primary outcome was total intubation time, defined as the time from when the anesthesiologist picked up the device to the time when three successive end-tidal CO2 waves were obtained following intubation. Secondary outcomes were blood in the endotracheal tube and trauma to the oral tissues or teeth. A blind observer assessed the presence of sore throat one hour and 24 hr after surgery.
Results The total intubation time was significantly different between group M and group V (96.1 sec and 78.1 sec,respectively; mean difference, 18 sec; 95% confidence interval (CI), 13.7 to 49.7). The incidence of epistaxis in groupMwas significantly greater than that in group V (46.7% vs 16.7%, respectively; relative risk, 2.8; 95% CI, 1.2 to 6.8).
Conclusion The total intubation time was significantly less with the vascular forceps (and tube exchanger) than with the Magill forceps. Using vascular forceps also reduced the incidence of epistaxis compared with that using the Magill forceps. Using a tube exchanger and vascular forceps offers advantages over use of Magill forceps when a GlideScope video laryngoscope is used for nasotracheal intubation
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