Wu Lingeer, Shen Le, Zhang Yuelun, Zhang Xiuhua, Huang Yuguang
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BMC Anesthesiol. 2018 May 31;18(1):59. doi: 10.1186/s12871-018-0521-9.
Arytenoid dislocation (AD) is a rare but severe complication after general anesthesia with endotracheal intubation. We conducted a case-control study at Peking Union Medical College Hospital to identify risk factors associated with AD, including the use of an intubation stylet.
Patients who experienced AD were matched 1:3 with controls based on gender, age and type of surgery. Multiple conditional logistic regression was performed to determine associations between potential risk factors and AD.
Twenty-six AD cases were retrospectively identified from 2004 through 2016. On average, arytenoid dislocation occurred in 2 cases per year, with an incidence of 0.904/100,000 (approximately 0.01%). The 26 patients who experienced AD and 78 matched control patients were enrolled in this study. All enrolled patients underwent endotracheal intubation, and a stylet was used for intubation for 38.5% (10/26) of the AD patients and 64.1% (50/78) of the controls (OR = 0.23, 0.07-0.74). A higher incidence of AD was significantly associated with longer duration of operation (OR = 1.74, 1.23-2.47).
The use of an intubation stylet for endotracheal intubation appears to protect against AD. Prolonged operation time increases the risk of AD. These factors should be considered when assessing the risks of AD associated with endotracheal intubation and in efforts to avoid this complication.
杓状软骨脱位（AD）是气管内插管全身麻醉后一种罕见但严重的并发症。我们在北京协和医院开展了一项病例对照研究，以确定与AD相关的危险因素，包括使用插管探条。
根据性别、年龄和手术类型，将发生AD的患者与对照组按1:3进行匹配。进行多因素条件logistic回归分析，以确定潜在危险因素与AD之间的关联。
回顾性分析2004年至2016年期间26例AD病例。平均每年发生2例杓状软骨脱位，发病率为0.904/10万（约0.01%）。本研究纳入了26例发生AD的患者和78例匹配的对照患者。所有纳入患者均接受气管内插管，38.5%（10/26）的AD患者和64.1%（50/78）的对照患者插管时使用了探条（比值比[OR]=0.23，0.07 - 0.74）。AD的较高发病率与手术时间延长显著相关（OR = 1.74，1.23 - 2.47）。
气管内插管时使用插管探条似乎可预防AD。手术时间延长会增加AD的风险。在评估气管内插管相关AD风险以及避免这一并发症时应考虑这些因素。
