比较两种气管插管技术之间插管时模拟颈椎制动患者的颈椎活动情况：喉镜辅助与常规光棒插管
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A Randomized Crossover Study Comparing Cervical Spine Motion During Intubation Between Two Lightwand Intubation Techniques in Patients With Simulated Cervical Immobilization: Laryngoscope-Assisted Versus Conventional Lightwand Intubation
背景与目的
在颈椎固定的患者，双手托颌法可导致颈椎运动, 同时使用喉镜可辅助光棒插管，在没有双手托下颌的情况下让光棒在口腔中也能摆在正中位置，且能自由移动。我们比较了喉镜辅助光棒插管（LALI）和常规光棒插管（CLI）在模拟颈椎固定患者中气管插管时颈椎运动的情况。
方 法
在这项随机交叉研究中，我们测量了LALI和CLI两种技术下模拟颈椎固定患者插管前、插管时枕骨-C1,C1-C2,C2-C5的颈椎夹角。颈椎运动的定义是从颈段测量的角度在插管过程中的变化。
结 果
用LALI和CLI技术时枕骨-C1的颈椎运动分别为5.6° (4.3) 和9.3° (4.5)（平均差（98.33%可信区间）-3.8° [-7.2 to -0.3]; P = 0.007）。其它颈段，结果没有统计学差异(C1-C2：-0.1° [-2.6 to 2.5]; P =0 .911，C2-C5:-0.2° [-2.8 to 2.5]; P = 0.795)。
结 论
和CLI相比，LALI技术在模拟颈椎固定患者气管插管时引起的上颈椎运动更少。
原始文献摘要
Tae Kyong Kim, Je-Do Son; A Randomized Crossover Study Comparing Cervical Spine Motion During Intubation Between Two Lightwand Intubation Techniques in Patients With Simulated Cervical Immobilization: Laryngoscope-Assisted Versus Conventional Lightwand Intubation ; Anesth Analg. 2017 Aug;125(2):485-490.
PURPOSE:
In patients with cervical immobilization, jaw thrust can cause cervical spine movement. Concurrent use of a laryngoscope may facilitate lightwand intubation, allowing midline placement and free movement of the lightwand in the oral cavity without jaw thrust. We compared the effects of laryngoscope-assisted lightwand intubation (LALI) versus conventional lightwand intubation (CLI) on cervical spine motion during intubation in patients with simulated cervical immobilization.
METHODS:
In this randomized crossover study, the cervical spine angle was measured before and during intubation at the occiput-C1, C1-C2, and C2-C5 segments in 20 patients with simulated cervical immobilization who underwent intubation using both the LALI and CLI techniques. Cervical spine motion was defined as the change from baseline in angle measured at each cervical segment during intubation.
RESULTS:
Cervical spine motion at the occiput-C1 segment was 5.6° (4.3) and 9.3° (4.5) when we used the LALI and CLI techniques, respectively (mean difference [98.33% CI]; -3.8° [-7.2 to -0.3]; P = .007). At other cervical segments, it was not significantly different between the 2 techniques (-0.1° [-2.6 to 2.5]; P = .911 in the C1-C2 segment and -0.2° [-2.8 to 2.5]; P = .795 in the C2-C5 segment).
CONCLUSION:
The LALI technique produces less upper cervical spine motion during intubation than the CLI technique in patients with simulated cervical immobilization.
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