阻塞性睡眠呼吸暂停与困难气道管理相关的危险因素——叙述性综述。

Obstructive sleep apnea as a risk factor associated with difficult airway management - A narrative review.

机构信息

Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Anaesthesia, National University Hospital, National University Health System, Singapore.

Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Anaesthesia, The Townsville Hospital and Health Services, James Cook University, Townsville, Queensland, Australia.

出版信息

J Clin Anesth. 2018 Mar;45:63-68. doi: 10.1016/j.jclinane.2017.12.024. Epub 2018 Jan 4.

DOI:10.1016/j.jclinane.2017.12.024

PMID:29291467

Abstract

STUDY OBJECTIVE

The association between obstructive sleep apnea (OSA) and difficult airway had been studied in various clinical trials but the relationship between the two conditions has not been clearly established. The objective of this narrative review is to determine if OSA is a risk factor associated with difficult airway.

DESIGN

The OVID Medline in process, Medline (vis Pub Med), EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS were searched up to April 2016 using specific keywords. Inclusion criteria were: [1] airway management in patients with a diagnosis of OSA, [2] comparison of airway management between OSA and non-OSA patients, [3] publications or abstracts in the English language. The incidence of difficult airway between OSA and non-OSA patients was compared using Chi-square analysis or Fisher's exact test.

MAIN RESULTS

Ten studies were included in the final review. Overall, the incidence of difficult tracheal intubation was higher in OSA patients versus non-OSA patients [56/386 (14.5%) vs. 69/897 (7.7%); P=0.0002]. OSA patients also have a higher incidence of difficult mask ventilation [115/4626 (2.5%) vs. 471/64,684 (0.7%); P<0.0001]. Compared to non-OSA patients, OSA was not associated with difficulty in the use of a supraglottic airway (SGA) device [10/663 (1.5%) vs. 162/15,171 (1.1%); P=0.38]. No studies compared difficult surgical airway in OSA and non-OSA patients.

CONCLUSIONS

OSA was found to be a risk factor associated with difficult tracheal intubation and difficult mask ventilation. There was no association between OSA and difficult SGA use.

摘要

研究目的

阻塞性睡眠呼吸暂停（OSA）与困难气道之间的关系已在各种临床试验中进行了研究，但这两种情况之间的关系尚未明确确定。本叙述性综述的目的是确定 OSA 是否是与困难气道相关的危险因素。

设计

在 2016 年 4 月之前，使用特定关键字对 OVID Medline 进行了搜索，包括 Medline（通过 Pub Med）、EMBASE、Cochrane 中央对照试验注册中心、Cochrane 系统评价数据库、Web of Science 和 SCOPUS。纳入标准为：[1] 诊断为 OSA 的患者的气道管理，[2] OSA 与非 OSA 患者之间的气道管理比较，[3] 以英语发表的出版物或摘要。使用卡方检验或 Fisher 精确检验比较 OSA 和非 OSA 患者之间困难气道的发生率。

主要结果

最终综述纳入了 10 项研究。总体而言，OSA 患者中困难气管插管的发生率高于非 OSA 患者[56/386（14.5%）比 69/897（7.7%）；P=0.0002]。OSA 患者中困难面罩通气的发生率也更高[115/4626（2.5%）比 471/64684（0.7%）；P<0.0001]。与非 OSA 患者相比，OSA 与使用声门上气道（SGA）装置的困难程度无关[10/663（1.5%）比 162/15171（1.1%）；P=0.38]。没有研究比较 OSA 和非 OSA 患者的困难外科气道。