Herway S T, Benumof J L
Assistant Clinical Professor, Department of Anesthesiology, University of California San Diego, CA, USA.
Professor, Department of Anesthesiology, University of California San Diego, CA, USA.
Anaesth Intensive Care. 2017 Mar;45(2):177-188. doi: 10.1177/0310057X1704500207.
The purpose of this review is to, first, determine the static factors that affect the length of the human trachea across different populations and, second, to investigate whether or not there are dynamic factors that cause the length of the human trachea to vary within the same individual. We also investigated whether these changes in tracheal length within the same individual are significant enough to increase the risk of endobronchial intubation or accidental extubation. A PubMed/MEDLINE and a Web of Science database English-language literature search was conducted in May 2016 with relevant keywords and MeSH terms when available. We found that gender, extremes of age, patient height, postsurgical changes and co-existing disease are static patient factors that affect the length of the human trachea. Dynamic clinical changes that occur under anaesthesia, including Trendelenburg position, head and neck flexion and extension, paralysis of the diaphragm and pneumoperitoneum, cause the trachea to act as an accordion, decreasing and increasing its length. The length of the human trachea in both awake and anaesthetised and paralysed patients is a critical consideration in preventing both endobronchial intubation and tracheal extubation. It is clear from the literature that tracheal length varies widely across populations and, additionally, with the dynamic clinical changes that occur under anaesthesia, the trachea acts as an accordion decreasing and increasing its length within the same individual. Knowledge of the magnitude of the change in tracheal dimensions in response to these factors is an important clinical consideration.
本综述的目的，其一，是确定影响不同人群中人类气管长度的静态因素；其二，是研究是否存在导致同一个体内人类气管长度发生变化的动态因素。我们还研究了同一个体内气管长度的这些变化是否足以增加支气管内插管或意外拔管的风险。2016年5月，利用相关关键词及可用的医学主题词，对PubMed/MEDLINE和科学网数据库进行了英文文献检索。我们发现，性别、年龄极值、患者身高、术后变化和并存疾病是影响人类气管长度的静态患者因素。麻醉状态下发生的动态临床变化，包括头低脚高位、头颈部屈伸、膈肌麻痹和气腹，会使气管像手风琴一样，长度缩短和增加。清醒、麻醉和麻痹患者的气管长度是预防支气管内插管和气管拔管的关键考虑因素。从文献中可以清楚地看到，气管长度在不同人群中差异很大，此外，由于麻醉状态下发生的动态临床变化，气管在同一个体内会像手风琴一样长度缩短和增加。了解气管尺寸因这些因素而发生变化的幅度是一项重要的临床考量。
