摘要
目的探讨强直性脊柱炎(AS)患者插管困难的程度,预测全身麻醉(简称全麻)插管方法选择的影响因素。方法回顾性分析2008年1月至2017年1月AS行手术治疗患者347例,男276例,女71例,年龄15~77岁,美国麻醉医师协会(ASA)评分Ⅰ~Ⅲ级。全麻诱导过程中根据是否应用可视设备插管分为两组:可视组(V组,n=168)和非可视组(N组,n=179)。收集资料包括性别、年龄、脊柱后凸、张口度、马氏分级、颈部活动度、AS时间。对变量进行分析,推测AS患者气管插管困难时插管方式选择的相关因素。结果V组年龄明显大于N组(P<0.05),脊柱后凸发生率、张口度、马氏分级、颈部活动度受限分级明显高于N组(P<0.05),AS时间明显长于N组(P<0.05)。多因素Logistic回归分析提示颈部活动度中度受限(OR=5.41,95%CI:2.32~13.10,P<0.001)、重度受限(OR=9.22,95%CI:4.37~20.25,P<0.001)是患者困难气道提示应用可视设备进行气管插管术的相关因素。结论颈部活动度对于是否使用可视设备影响较大,当颈部活动度下降时,麻醉科医师更倾向于使用McCoy喉镜、可视硬质及纤维支气管镜等可视设备。
Objective To investigate the degree of difficult intubations for patients with ankylosing spondylitis(AS)and to predict the related factors influencing the selection of intubation methods.Methods A total of 347 patients(276 males,71 females),aged 15-77 years,ASAⅠ-Ⅲwith AS underwent surgical procedure from January 2008 to January 2017 were included.During general anesthesia induction,patients were divided into two groups according to the application of non-visual devices(179 cases)and visual devices(168 cases).Patient data were collected,including gender,age,kyphosis,degree of mouth opening,Mallampatti classification,neck mobility and the duration of the AS.Multivariate regression analysis of variables was conducted to find the relevant predictors of intubations method selection in AS patients with difficult endotracheal airway.Results The older patients,kyphosis,limited mouth opening,limited neck range of motion,and longer duration of AS,the utilization rate of the visual group was significantly higher than that of the non-visual group(P<0.05).Multi-factor Logistic regression analysissuggested that moderate limitation of neck range of motion(OR=5.41,95%CI:2.32-13.10,P<0.001)and severe limitation of neck range of motion(OR=9.22,95%CI:4.37-20.25,P<0.001)were related factors for tracheal intubation with visual devices in patients with difficult airway.Conclusions Neck mobility has a great influence on whether or not to use visual intubation tools.When neck mobility decreases,anesthesiologists are more likely to use visual devices such as video laryngoscope,McCoy laryngoscope,visual rigid and fiberoptic bronchoscope.
作者
张羽冠
校搏
张越伦
易杰
ZHANG Yu-guan;XIAO Bo;ZHANG Yue-lun;YI Jie(Department of Anesthesiology;Medical Research Center, Peking Union Medical College Hospital,CAMS & PUMC, Beijing 100730, China)
出处
《基础医学与临床》
2022年第5期795-798,共4页
Basic and Clinical Medicine
关键词
强直性脊柱炎
困难气道
全身麻醉插管
相关因素
可视设备
ankylosing spondylitis
difficult airway
general anesthesia and intubation
related factors
visible devices
