Title: Considering "The Lethal Duo" when Intubating the patient with TBI
题目：创伤性颅脑损伤进行气管插管时需要考虑“致命双剑”
Author 作者: John Greenwood
江利冰 译 肖锋 校

Direct vs. video laryngoscopy in the patient with an acute TBI
急性创伤性颅脑损伤中直接喉镜和可视喉镜的比较
Hypoxia and hypotension are considered the "lethal duo" in patients with traumatic brain injury.  In a recent randomized control trial (by our own Dr. Dale Yeatts at the Shock Trauma Center) mortality outcomes were compared between 623 consecutive patients who were intubated with either direct laryngoscopy (DL) or video laryngoscopy (VL).  Here is what they found:
缺氧和低血压被认为是创伤性颅脑损伤的“致命双剑”。最近的一项随机对照研究（由我们自己的医生Dale Yeatts在创伤中心开展的）对623例先后陆续入院的患者，比较了直接喉镜下的气管插管和可视喉镜下的气管插管患者的死亡率。下面是他们发现的结果：
No significant difference in mortality for all comers (Primary Outcome)；
2. In the subset of patients with severe head injuries, there was:
1. 对于所有的患者，死亡率没有区别（主要观察指标）；2. 对于伴有严重颅脑损伤的患者，得出以下结论：
A significantly higher mortality in patients with TBI if VL was used
创伤性颅脑损伤的患者如果进行可视喉镜下的气管插管，死亡率明显增高。
A significantly longer intubation duration for VL (74 sec) than DL (65 sec)
可视喉镜下的气管插管时间（74秒）显著长于直接喉镜下的气管插管时间（65秒。
A greater incidence of low oxygen saturations of 80% or less in the VL group (27 patients) than DL (15 patients) - objectively recorded data, not self reported.
氧饱和度等于或低于80%的发生率在可视喉镜气管插管组（27例）显著高于直接喉镜下的气管插管组（15例）。

There is a reasonable amount of literature that shows hypoxia and hypotension significantly contribute to morbidity & mortality in the TBI patient, and a growing body of literature that suggests intubation with VL takes longer than DL.
已经具有合理数量的文献显示低氧和低血压明显增加创伤性颅脑损伤患者的并发症发生率和死亡率，并且越来越多的文献指出使用可视喉镜进行气管插管比直接喉镜下的气管插管花费更长的时间。
Bottom Line: When choosing a method of intubation for the TBI patient, remember the "Lethal Duo" and consider direct laryngoscopy with manual inline stabilization first.
要点：当为创伤性颅脑损伤患者选择气管插管的方法时，请记住这“致死双剑”，并且首先考虑在用手保证颈椎中线下应用直接喉镜。
References
参考文献

Yeatts DJ, Dutton RP, Hu PF, et al. Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial[J]. J Trauma Acute Care Surg. 2013;75(2):212-219.