鼾症患者气道管理困难的多因素分析.DOCVIP

临床医学论文-鼾症患者气道管理困难的多因素分析 ??????????????????????? 作者：张旭,白浪,陈英子,周守静?? 【关键词】? 睡眠呼吸暂停综合征；插管法,气管内；综合评估法；多因素 　　【摘要】? 目的? 分析阻塞性睡眠呼吸暂停综合征（OSAS）患者困难气道的多项评估指标。方法? 选择125例行悬雍垂-腭-咽成形（uvulopalatopharyngiplasty,UPPP）手术的OSAS患者,分析与气管插管相关的多项因素，包括困难气管插管病史、年龄、性别、身高、体重、体重指数（BMI）、颈围、上下切牙间距、甲颏间距、颈部后仰度、下颌骨活动情况、门齿有无突出、有无小颌畸形、改良Mallampati分级、呼吸暂停指数（AHI）等。插管困难的标准为Cormack-Lehane喉头分级3~4级。结果? 鼾症患者插管困难的相关危险因素为：改良Mallampati分级、上下切牙间距和颈部后仰度，其相对危险度分别为2.19、0.33（P＜0.01）、4.58（P＜0.05）。综合此三项指标，以总分5认为存在插管困难作为简易预测OSAS患者术前插管困难的综合评估指标，与传统的单项改良Mallampati分级试验和Wilson评分法比较实际插管困难发生率，得出简易的综合评估法敏感度高（85%）（P＜0.05），漏诊率低（19%）（P＜0.05）。结论? 在OSAS患者中综合改良Mallampati分级、上下切牙间距和颈部后仰度三项评估指标，可简易预测此类患者插管困难的情况。 ??? 【关键词】? 睡眠呼吸暂停综合征；插管法，气管内；综合评估法；多因素 ???? Multivariate risk index of difficult airway management in obstructive sleep apnea syndrom ??? ZHANG Xu,BAI Lang,CHEN Ying-zi，et al.Department of Anesthesiology, EENT Hospital, Fudan University, Shanghai 200031,China. ??? 【Abstract】? Objective? The purpose of this study is to develop a clinically useful model for predicting difficult tracheal intubation （DI） in patients with obstructive sleep apnea syndrome（OSAS） undergoing uvulopalatopharyngiplasty（UPPP） surgery.Methods? Among 125 OSAS patients were selected to compare several multifactorial clinical indexes for predicting DI. Multivariate logistic regression analysis was used to examine the relative risk factors including previous knowledge of DI, sex, age, weight, body mass index （BMI）, apnea hypopnea index （AHI）， cervical morphology, inter-incisor gap（IG）, thyromental distance, subluxation, atlanto-occipital extension, micrognathia, Mallampati’s modified test, tooth morphology.The standard of DI was assessed by the anaesthesiologist during laryngoscopy by using the Cormack-Lehane classification and was defined as Grade Ⅲ or Ⅳ.Results? The relative risk factors of DI were:Mallampati’s modified test，upper-lower incisor teeth distance and neck upward degree （ relative risks were 2.19,0.33,4.58 respectively,P＜0.05）. A simple and clini