颈椎手术成人患者中视频喉镜与Macintosh直接喉镜气管插管时的颈椎运动：一项随机对照试验
Cervical spine motion during tracheal intubation with videolaryngoscopy versus macintosh laryngoscopy in adults undergoing cervical spine surgery: a randomized controlled trial.
文献信息
| PMID | 42880586 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Hieu Trung Doan |
| 作者单位 | Bach Mai Hospital, Center for Anesthesia and Surgical Intensive Care, Hanoi, Vietnam. |
| 期刊 | Brazilian journal of anesthesiology (Elsevier) |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 气管插管过程中过度的颈椎运动可能增加颈椎病变患者的神经风险。与Macintosh直接喉镜相比，视频喉镜可能减少颈椎运动，但任何生物力学上的减少应与神经保护区分开来。
方法： 计划择期颈椎手术的成人按1:1随机分配至使用ClearVue视频喉镜（V组）或Macintosh喉镜（M组）插管，并采用手动直线稳定。在喉镜检查前即刻（G0，中立位）和声门暴露最佳时（G1）获取侧位透视图像。预设主要终点为直接测量的累积C0‒C5颈椎运动。还计算了C0‒C1、C1‒C2、C2‒C3、C3‒C4和C4‒C5的颈椎运动（ΔG）。ΔG以度（°）表示。
结果： 56例患者被随机分组并分析（每组28例）。C0‒C5的平均（SD）ΔG在V组为19.71（4.75），在M组为26.32（8.46）（平均差[M‒V]，6.61；95% CI 2.91‒10.31；p < 0.001）。在C0‒C1，ΔG分别为2.68（2.53）与4.68（2.42）（差值=2.00；95% CI 0.67‒3.33；p=0.004）。首次尝试成功率分别为89.3%（25/28）与78.6%（22/28）（p=0.47）。在首次尝试成功插管的患者中，V组插管时间（21.75 ± 3.64秒）短于M组（31.71 ± 21.25秒）。
结论： 与Macintosh直接喉镜相比，ClearVue视频喉镜减少了透视测量的上颈椎运动和直接测量的累积C0‒C5运动。这些发现应解释为生物力学替代结局，而非神经保护的证据。
英文摘要
BACKGROUND: Excessive cervical spine motion during tracheal intubation may increase neurological risk in individuals with cervical spine pathology. Videolaryngoscopy may reduce cervical motion compared with Macintosh direct laryngoscopy, but any biomechanical reduction should be distinguished from neurological protection.
METHODS: Adults scheduled for elective cervical spine surgery were randomized 1:1 to intubation with a ClearVue videolaryngoscope (group V) or a Macintosh laryngoscope (group M) under manual in-line stabilization. Lateral fluoroscopy was acquired immediately before laryngoscopy (G0, neutral position) and at best glottic view (G1). The prespecified primary endpoint was directly measured cumulative C0‒C5 cervical motion. Cervical spine motion (ΔG) was also calculated at C0‒C1, C1‒C2, C2‒C3, C3‒C4 and C4‒C5. ΔG was expressed in degrees (°).
RESULTS: Fifty-six patients were randomized and analyzed (28 per group). Mean (SD) ΔG at C0‒C5 was 19.71 (4.75) in group V and 26.32 (8.46) in group M (mean difference [M‒V], 6.61; 95% CI 2.91‒10.31; p < 0.001). At C0‒C1, ΔG was 2.68 (2.53) vs. 4.68 (2.42) (difference = 2.00; 95% CI 0.67‒3.33; p = 0.004). First-attempt success was 89.3% (25/28) vs. 78.6% (22/28) (p = 0.47). Among patients intubated successfully on the first attempt, intubation time was shorter in group V (21.75 ± 3.64s) than group M (31.71 ± 21.25s).
CONCLUSION: ClearVue videolaryngoscopy reduced fluoroscopically measured upper cervical and directly measured cumulative C0‒C5 motion compared with Macintosh direct laryngoscopy. These findings should be interpreted as biomechanical surrogate outcomes, not as evidence of neurological protection.