口腔或口咽癌患者气道管理的数据回顾：单机构经验。
A data review of airway management in patients with oral cavity or oropharyngeal cancer: a single-institution experience.
机构信息
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Faculty Center - Unit 409, Houston, TX, 77030, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, FCT4.5047, T. Boone Pickens Academic Tower, 1400 Pressler St, Houston, TX, 77030-4008, USA.
出版信息
BMC Anesthesiol. 2019 Jun 1;19(1):92. doi: 10.1186/s12871-019-0770-2.
BACKGROUND
Oral cavity and oropharyngeal cancer impose significant threat to airway management. Head and neck radiotherapy (HNRT) may further increase the difficulty of tracheal intubation. We hypothesized that a history of HNRT would be associated with a high rate of difficult tracheal intubation.
METHODS
Adult patients with a history of HNRT were identified. Non-HNRT controls were case-matched by age, sex and body mass index. The tracheal intubation status between the two patient groups (treated vs. untreated with HNRT) was compared. The t test was used to evaluate differences in continuous variables between the 2 groups. Fisher's exact test or a chi-square test was used to test for associations between radiation status and patient characteristics that may be associated with difficult tracheal intubation. Odds ratio and its confidence interval were used to assess the effect of radiation status on intubation status.
RESULTS
The final cohort of 472 matched patients in age, sex and body mass index consisted of 236 patients who had HNRT before surgery and 236 who had upfront surgery without HNRT. The percentage of patients who had restricted neck range of motion in the HNRT group was significantly higher than in the control group (22.3% vs. 11.0%; p = 0.001). The proportion of patients with trismus (p = 0.11) or difficult tracheal intubation (p = 0.73) did not differ significantly between the 2 groups. 12.7% patients in the study had difficult tracheal intubation. Patients who had mallampati scores of 3 or 4 had significantly higher rate of difficult tracheal intubation than did patients with mallampati scores of 1 or 2 (17.8% vs. 8.7%; p = 0.004). Multivariate logistic regression model showed no difference between HNRT and intubation status after adjusting neck range of motion and mallampati score (OR = 0.91, 95% CI: 0.510 to1.612).
CONCLUSIONS
Previous treatment with HNRT was not associated with additional risk of difficult tracheal intubation. Mallampati score may be a sensitive measurement for difficult tracheal intubation in this patient population.
背景
口腔和口咽癌对气道管理构成重大威胁。头颈部放疗（HNRT）可能进一步增加气管插管的难度。我们假设 HNRT 病史与气管插管困难的发生率较高有关。
方法
确定有 HNRT 病史的成年患者。非 HNRT 对照组按年龄、性别和体重指数匹配。比较两组患者（HNRT 治疗组和未治疗组）的气管插管情况。使用 t 检验评估两组间连续变量的差异。Fisher 确切检验或卡方检验用于检验与气管插管困难可能相关的辐射状态和患者特征之间的关联。使用比值比及其置信区间评估辐射状态对插管状态的影响。
结果
在年龄、性别和体重指数上匹配的 472 例最终队列中，有 236 例患者在手术前接受了 HNRT，236 例患者在没有 HNRT 的情况下进行了手术。HNRT 组颈部活动范围受限的患者比例明显高于对照组（22.3% vs. 11.0%；p=0.001）。两组患者中张口受限（p=0.11）或气管插管困难（p=0.73）的比例无显著差异。研究中有 12.7%的患者出现气管插管困难。Mallampati 评分 3 或 4 的患者的气管插管困难发生率明显高于 Mallampati 评分 1 或 2 的患者（17.8% vs. 8.7%；p=0.004）。多变量逻辑回归模型显示，调整颈部活动范围和 Mallampati 评分后，HNRT 与插管状态之间无差异（OR=0.91，95%CI：0.510 至 1.612）。
结论
先前接受 HNRT 治疗与气管插管困难的风险增加无关。Mallampati 评分可能是该患者人群中气管插管困难的敏感测量指标。
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