Zhang Yu, Guo Xiaopeng, Pei Lijian, Zhang Zhuhua, Tan Gang, Xing Bing
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
Endocrine. 2017 Aug;57(2):326-334. doi: 10.1007/s12020-017-1338-x. Epub 2017 Jun 15.
To investigate the characteristics of difficult intubation and identify novel efficient predictors in patients with acromegaly.
Patients with either untreated acromegaly or non-functional pituitary adenomas were enrolled. Patients with acromegaly underwent hormone assays, upper airway computed tomography and magnetic resonance imaging examinations and preoperative overnight polysomnography. The modified Mallampati classification, mouth opening, neck circumference, and neck extension were assessed, and the Cormack-Lehane grades and the time of tracheal intubation were recorded.
Patients with acromegaly had a higher incidence of difficult intubation (62.5%). The time of tracheal intubation was prolonged, the neck circumference was enlarged, and the neck extension was confined. In patients with acromegaly and difficult intubation, the insulin-like growth factor 1 levels and apnea/hypoxia index were significantly higher compared to patients without difficult intubation (1115.40 ± 253.73 vs. 791.67 ± 206.62 ng/ml, P = 0.020; 22.17 ± 23.25 vs. 2.47 ± 2.84, P = 0.026, respectively). The bilateral regression analysis revealed that high levels of insulin-like growth factor 1 were an independent risk factor for developing difficult intubation (p = 0.042, Exp B = 1.006). The modified Mallampati classification was positively correlated with apnea/hypoxia index and could be calculated using the following logarithmic equation: MMC = 0.2982 * ln (AHI) + 2.1836.
In patients with acromegaly, neck movement is confined, the time of tracheal intubation is prolonged, and the neck circumference is enlarged, and these patients suffer from an increased incidence of difficult intubation (62.5%) during anesthesia induction. The apnea/hypoxia index and insulin-like growth factor 1 levels are both increased in acromegalic patients with difficult intubation, and elevated insulin-like growth factor 1 levels are an independent risk factor of difficult intubation in acromegalic patients.
探讨肢端肥大症患者困难插管的特点，并确定新的有效预测指标。
纳入未经治疗的肢端肥大症患者或无功能性垂体腺瘤患者。肢端肥大症患者接受激素测定、上气道计算机断层扫描和磁共振成像检查以及术前整夜多导睡眠图检查。评估改良Mallampati分级、开口度、颈围和颈部伸展度，并记录Cormack-Lehane分级和气管插管时间。
肢端肥大症患者困难插管的发生率较高（62.5%）。气管插管时间延长，颈围增大，颈部伸展受限。与无困难插管的患者相比，肢端肥大症且有困难插管的患者胰岛素样生长因子1水平和呼吸暂停/低氧指数显著更高（分别为1115.40±253.73 vs. 791.67±206.62 ng/ml，P = 0.020；22.17±23.25 vs. 2.47±2.84，P = 0.026）。双侧回归分析显示，胰岛素样生长因子1水平升高是发生困难插管的独立危险因素（p = 0.042，Exp B = 1.006）。改良Mallampati分级与呼吸暂停/低氧指数呈正相关，可使用以下对数方程计算：MMC = 0.2982 * ln(AHI) + 2.1836。
肢端肥大症患者颈部活动受限，气管插管时间延长，颈围增大，这些患者在麻醉诱导期间困难插管的发生率增加（62.5%）。肢端肥大症且有困难插管的患者呼吸暂停/低氧指数和胰岛素样生长因子1水平均升高，胰岛素样生长因子1水平升高是肢端肥大症患者困难插管的独立危险因素。
