鼻咽癌放疗后困难气管插管和气道结果。

Difficult Tracheal Intubation and Airway Outcomes after Radiation for Nasopharyngeal Carcinoma.

机构信息

Stanford Hospital, Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA.

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA.

出版信息

Laryngoscope. 2024 Jan;134(1):120-126. doi: 10.1002/lary.30767. Epub 2023 May 30.

DOI:10.1002/lary.30767

PMID:37249176

Abstract

OBJECTIVE

The aim of the study was to characterize the incidence and management of difficult tracheal intubations (DTIs) in nasopharyngeal carcinoma (NPC) after primary radiation therapy (RT).

METHODS

The study was a retrospective review of airway assessment and outcomes in post-RT NPC patients. Primary analysis was performed on patients who underwent post-RT procedures, who were split into non-DTI and DTI groups. Patients were classified as DTI if they (i) required >1 attempt to intubate, (ii) failed to be intubated, or (iii) experienced complications attributed to airway management. Secondary analysis was performed between patients who underwent post-RT procedures (procedure group) and those who did not (control group).

RESULTS

One-hundred and fifty patients were included, and 71.3% underwent post-RT procedures, with no differences in characteristics between the procedure and control groups. One-hundred and fifty procedures were identified, and 28.0% were categorized as DTI. There was no difference in patient characteristics or airway assessment measures between DTI and non-DTI groups. Regression analysis revealed concurrent cervical mobility restriction, and trismus increased DTI incidence by 7.1-fold (p = 0.011). Being non-White was an independent predictor of DTI. The incidence of high-grade intraoperative laryngoscopic view was lower in the non-DTI compared to the DTI group (20.4% vs. 64.3%, p < 0.0001). Failure to intubate occurred in 2.0% of cases, and 6.0% cases had perioperative complications. Based on preoperative assessment, sensitivity of predicting DTI was 54.8% and specificity was 63.9%.

CONCLUSION

NPC patients frequently undergo post-RT procedures requiring complex airway management. Rates of DTI and failed intubation are significantly higher than those in the general surgical population, and the ability to predict DTI with standard preoperative airway measures is poor.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:120-126, 2024.

摘要

目的

本研究旨在描述鼻咽癌（NPC）患者在接受根治性放疗（RT）后行气管插管困难（DTI）的发生率和处理方法。

方法

本研究回顾性分析了 NPC 患者在接受 RT 后进行气道评估和结局的情况。主要分析对象为接受 RT 后治疗的患者，他们分为非 DTI 组和 DTI 组。如果患者（i）需要 >1 次尝试插管，（ii）无法插管，或（iii）出现归因于气道管理的并发症，则被归类为 DTI。对接受 RT 后治疗的患者（治疗组）和未接受治疗的患者（对照组）进行了二次分析。

结果

共纳入 150 例患者，其中 71.3%的患者接受了 RT 后治疗，治疗组和对照组在患者特征方面无差异。共进行了 150 次治疗，其中 28.0%被归类为 DTI。DTI 组和非 DTI 组患者特征和气道评估措施无差异。回归分析显示，同期颈椎活动受限和牙关紧闭使 DTI 发生率增加 7.1 倍（p = 0.011）。非白人是 DTI 的独立预测因素。非 DTI 组术中喉镜检查分级较高的比例明显低于 DTI 组（20.4%比 64.3%，p < 0.0001）。2.0%的病例插管失败，6.0%的病例围手术期发生并发症。基于术前评估，预测 DTI 的敏感性为 54.8%，特异性为 63.9%。