全身麻醉诱导期间困难气道的发生率及相关因素
Magnitude and Predisposing Factors of Difficult Airway during Induction of General Anaesthesia.
作者信息
Workeneh Sileshi Abiy, Gebregzi Amare Hailekiros, Denu Zewditu Abdissa
机构信息
College of Medicine and Health Science, Department of Anesthesiology and Critical Care, University of Gondar, Gondar, Ethiopia.
出版信息
Anesthesiol Res Pract. 2017;2017:5836397. doi: 10.1155/2017/5836397. Epub 2017 Jul 11.
OBJECTIVE
To assess magnitude and predisposing factors of difficult airway during induction of general anaesthesia.
METHODS
Hospital based cross sectional study carried out to determine the incidence of difficult mask ventilation, difficult laryngoscopy (Cormack and Lehane III and IV), difficult intubation (IDS ≥ 5), and failed intubation. The association between each predisposing factor and airway parameters with components of difficult airway is investigated with binary logistic regression. Sensitivity, specificity, positive and negative predictive value of the test, and odds ratio with 95% confidence interval were calculated to determine the association between independent and dependent variable.
RESULT
The incidence of difficult laryngoscopy, difficult intubation, and failed intubation are 12.3%, 9%, and 0.005%, respectively. Mouth opening < 30 mm and Mallampati classes III and IV are the most sensitive tests and second high specific test next to combination of tests to predict difficult intubation and laryngoscopy ( value < 0.001). Unrestricted multiple attempt without alternative airway techniques resulted in exponential increase in desaturation episodes and further difficulty of airway management ( value < 0.001).
DISCUSSION AND CONCLUSION
Mallampati classes III and IV, mouth opening ≤ 30 mm, jaw slide grade C, attempt > 3, and ineffective alternative technique have increased predictability value of difficult airway.
目的
评估全身麻醉诱导期间困难气道的发生率及相关易感因素。
方法
开展一项基于医院的横断面研究，以确定困难面罩通气、困难喉镜检查（Cormack和Lehane III级及IV级）、困难插管（插管困难评分≥5分）及插管失败的发生率。采用二元逻辑回归分析各易感因素及气道参数与困难气道各组成部分之间的关联。计算检验的敏感性、特异性、阳性和阴性预测值以及95%置信区间的比值比，以确定自变量与因变量之间的关联。
结果
困难喉镜检查、困难插管及插管失败的发生率分别为12.3%、9%和0.005%。张口度<30 mm以及Mallampati III级和IV级是预测困难插管和喉镜检查最敏感的指标，也是仅次于联合检查的特异性第二高的检查（P值<0.001）。在没有备用气道技术的情况下无限制地多次尝试导致去饱和事件呈指数增加，进一步增加气道管理难度（P值<0.001）。
讨论与结论
Mallampati III级和IV级、张口度≤30 mm、下颌滑动C级、尝试次数>3次以及备用技术无效等因素增加了困难气道的预测价值。
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