普适性视频喉镜与麻醉学员插管结局：多中心VIDEOLAR-SURGERY试验的亚组分析

文献信息

中文摘要

背景： 气管插管是麻醉培训中的核心操作技能。视频喉镜可改善声门可视化和共享气道视野，但其在常规临床实践中对学员操作插管的影响仍不确定。方法：本亚组分析基于一项前瞻性、多中心、非随机前后对照研究，评估将视频喉镜作为普适性首选设备是否改善麻醉学员的插管表现。西班牙西北部八家医院贡献了1801例由学员操作的插管（干预前857例，干预后944例）。非干预阶段使用Macintosh镜片的直接喉镜，干预阶段系统采用McGrath MAC视频喉镜。主要结局为容易插管，定义为首次尝试成功、Cormack-Lehane分级I-IIa视野且未使用辅助手段。结果：视频喉镜下容易插管更常见（83.1% vs 69.3%；p < 0.001）。首次尝试成功率（87.9% vs 77.0%；p < 0.001）和良好声门可视化（91.5% vs 84.9%；p < 0.001）也更高。辅助手段使用、操作者更换和并发症均减少。改善在初级和高级学员组中均一致。结论：在常规手术室实践中，普适性视频喉镜与麻醉学员整体插管表现的改善相关。这些发现提示视频喉镜可能是支持气道管理培训并改善临床实践中插管条件的有价值工具。

英文摘要

Tracheal intubation is a core procedural skill in anaesthesia training. Videolaryngoscopy provides improved glottic visualisation and shared airway views, but its effect on trainee-performed intubations in routine clinical practice remains uncertain. This subanalysis of a prospective, multicentre, non-randomised before-and-after study evaluated whether adopting videolaryngoscopy as the universal first-intention device improved intubation performance among anaesthesia trainees. Eight hospitals in Northwest Spain contributed 1801 trainee-performed intubations (857 before and 944 after intervention). During the non-intervention phase, direct laryngoscopy with a Macintosh blade was used, whereas the McGrath MAC videolaryngoscope was systematically adopted during the intervention phase. The primary outcome was easy intubation, defined as first-attempt success, Cormack-Lehane grade I-IIa view and no adjunct use. Easy intubation occurred more frequently with videolaryngoscopy (83.1% vs 69.3%; p < 0.001). First-attempt success (87.9% vs 77.0%; p < 0.001) and favourable glottic visualisation (91.5% vs 84.9%; p < 0.001) were also higher. Adjunct use, operator change and complications were reduced. Improvements were consistent across both junior and senior trainee groups. Universal videolaryngoscopy was associated with improved overall intubation performance among anaesthesia trainees in routine operating room practice. These findings suggest that videolaryngoscopy may be a valuable tool to support airway management training and improve intubation conditions in clinical practice.