阻塞性睡眠呼吸暂停低通气综合征患者手术麻醉中困难气道发生的因素预测

doi:10.6040/j.issn.1673-3770.0.2017.396

摘要/Abstract

摘要： 目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者手术麻醉过程中发生困难气道的可预测因素形成原因,以降低该类患者围手术期急性呼吸道梗阻的风险。方法选择根据夜间多导睡眠监测(PSG)诊断为OSAHS、拟行悬雍垂腭咽成形术(UPPP)、符合病例纳入标准的患者128例,采用快诱导经口插管全身麻醉,记录患者发生困难通气和困难气管插管的情况,对相关临床资料进行统计学处理分析。结果 128例中发生困难面罩通气83例(64.8%),困难插管66例(51.6%)。体质量指数(BMI)、呼吸暂停低通气指数(AHI)、颈围(NC)、腰围(WC)、颈围/身高(NC/H)、腰围/身高(WC/H)、Mallampati气道分级及Cormack-Lehane喉头分级(C-L分级)与困难通气存在相关性;logistic回归分析显示,BMI、NC、Mallampati分级、C-L分级是困难通气的危险因素。BMI、AHI、WC、 WC/H、最低血氧饱和度(LSO₂)、上下切牙间距离(ICD)、Mallampati气道分级及C-L分级与困难气管插管存在相关性;AHI、C-L分级是困难气管插管的危险因素,ICD是困难插管的保护性因素。结论 OSAHS患者困难气道发生率较高;颈围、BMI、Mallampati分级、C-L分级是预测困难通气的重要因素;AHI、ICD、C-L分级对困难插管的发生有预测价值。

关键词: 急性呼吸道梗阻, 困难通气, 麻醉, 困难气管插管, 睡眠呼吸暂停,阻塞性

Abstract: Objective This study aimed to find predictors for difficult mask ventilation and intubation in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS), and to decrease the incidence of difficult airway during general anesthesia. Methods Based on the inclusion criteria, 128 OSAHS patients diagnosed by polysomnography were included in the study. After general anesthesia induction, the incidence of difficult mask ventilation and difficult intubation were recorded; patient characteristics were also documented. Univariate analyses were performed to identify the potential risk factors for difficult mask ventilation and difficult intubation. Factors identified as having a significant association with difficult mask ventilation and difficult intubation were then subjected to stepwise multiple logistic regression analysis, to evaluate confounding among these predictors. Results Difficult mask ventilation was present in 64.8%(83/128)of the OSAHS patients; the rate of difficult intubation was 51.6%(66/128). The univariate analyses showed that difficult mask ventilation was associated with body mass index(BMI), apnea-hypopnea index(AHI), neck circumference(NC), waist circumference(WC), neck circumference to height ratio(NC/H), waist circumference to height ratio(WC/H), Mallampati score, and Cormack and Lehane classification. Multiple logistic regression analysis showed that BMI, NC, Mallampati score, and Cormack and Lehane classification were independent predictors of difficult mask ventilation. Difficult intubation was associated with BMI, the lowest oxygen saturation(LSaO₂)level, AHI, WC, WC/H, interincisor distance(ICD), Mallampati score, and Cormack and Lehane classification. Multiple logistic regression analysis showed that AHI and Cormack and Lehane classification were independent predictors of difficult intubation; ICD was the protective factor for difficult intubation. Conclusion OSAHS patients presented with a high risk of difficult airway. BMI, NC, Mallampati score, and Cormack and Lehane classification were independent predictors of difficult mask ventilation. AHI, ICD, and Cormack and Lehane classification were 山东大学耳鼻喉眼学报31卷6期 -李玲,等.阻塞性睡眠呼吸暂停低通气综合征患者手术麻醉中困难气道发生的因素预测 \=-strongly linked with difficult intubation.

Key words: Anesthesia, Difficult mask ventilation, Difficult intubation, Acute respiratory obstruction, Obstructive sleep apnea hypopnea syndrome

中图分类号:

R766.7

李玲,王春玲,张丽,李延忠. 阻塞性睡眠呼吸暂停低通气综合征患者手术麻醉中困难气道发生的因素预测[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 62-67.

LI Ling, WANG Chunling, ZHANG Li, LI Yanzhong.. Predictors of difficult airway in patients with obstructive sleep apnea-hypopnea syndrome during general anesthesia.[J]. J Otolaryngol Ophthalmol Shandong Univ, 2017, 31(6): 62-67.

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