Lee Jeongwoo, Kim Jeong Seob, Kang Sehrin, Shin Yu Seob, Doo A Ram
Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, South Korea,
Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea,
Ther Clin Risk Manag. 2019 May 17;15:669-675. doi: 10.2147/TCRM.S195216. eCollection 2019.
Retropharyngeal hematoma following cervical spine trauma may lead to life-threatening upper airway obstruction and difficult airway management. This retrospective study was performed to investigate whether the extension of retropharyngeal space (RPS) was associated with difficult intubation by direct laryngoscopy in traumatic cervical spine injury.
Sixty-two patients who had undergone direct endotracheal intubation under general anesthesia for cervical spine surgery were retrospectively identified. Laryngoscopic grade by Cormack-Lehane (C-L) classification was collected; grade 1 or 2 was categorized as easy laryngoscopy, whereas grade 3 or 4 was categorized as difficult laryngoscopy. In these patients, RPS thickness and the proportions of RPS to the vertebral bodies were measured at the 2nd, 5th and 7th cervical spine levels using magnetic resonance imaging (MRI) of the cervical spine. Measures of RPS were compared between easy and difficult laryngoscopy. Relationships between measures of RPS and difficult laryngoscopy were analyzed with logistic regression analysis.
RPS thickness at C2 was significantly greater in difficult laryngoscopy (median 14.29 mm, IQR: 9.75-18.04) than easy laryngoscopy (median 5.10, IQR: 4.33-5.94, <0.001). Proportion of RPS to the C2 vertebral body were significantly higher in difficult laryngoscopy than in easy laryngoscopy (<0.001). RPS thickness and the proportion of RPS to the vertebral body were significantly associated with difficult laryngoscopy (OR=2.13, 95% CI: 1.38-3.30; <0.001 and OR=1.13, 95% CI: 1.05-1.21; <0.001, respectively).
RPS extension at the upper cervical spine level is associated with difficult direct laryngoscopy in traumatic cervical spine injury.
颈椎创伤后咽后血肿可能导致危及生命的上气道梗阻及困难气道管理。本回顾性研究旨在调查咽后间隙（RPS）的扩展是否与创伤性颈椎损伤患者直接喉镜下插管困难相关。
回顾性纳入62例行颈椎手术全身麻醉下直接气管插管的患者。收集Cormack-Lehane（C-L）分类的喉镜分级；1级或2级归类为喉镜检查容易，而3级或4级归类为喉镜检查困难。在这些患者中，使用颈椎磁共振成像（MRI）在第2、5和7颈椎水平测量RPS厚度以及RPS与椎体的比例。比较容易和困难喉镜检查之间的RPS测量值。采用逻辑回归分析RPS测量值与困难喉镜检查之间的关系。
困难喉镜检查时C2水平的RPS厚度（中位数14.29mm，四分位数间距：9.75 - 18.04）显著大于容易喉镜检查时（中位数5.10，四分位数间距：4.33 - 5.94，P<0.001）。困难喉镜检查时RPS与C2椎体的比例显著高于容易喉镜检查时（P<0.001）。RPS厚度以及RPS与椎体的比例与困难喉镜检查显著相关（OR = 2.13，95%置信区间：1.38 - 3.30；P<0.001以及OR = 1.13，95%置信区间：1.05 - 1.21；P<0.001）。
上颈椎水平的RPS扩展与创伤性颈椎损伤患者直接喉镜检查困难相关。
