乌鲁达× ×大学医学院手术室气道困难病例回顾性调查

Didem Alemdar, Selcan Akesen, Hülya Bilgin
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摘要

目的:通过预测气道控制中可能出现的困难,确保气道通畅和正确管理通气对预防麻醉相关并发症至关重要。我们的目的是确定术前评估结果在困难气道管理中的作用。方法:回顾性分析2010 ~ 2020年乌鲁达× ×大学医学院手术室气道困难患者的危重事件记录。共有613名患者,其记录可完全访问,分为儿科(18岁以下)和成人(18岁及以上)。结果:所有患者的气道维持成功率为98.7%。导致气道困难的病理情况是成人患者头颈部恶性肿瘤和儿童患者先天性综合征。导致气道困难的解剖原因为成人前喉(31.1%)和颈部肌肉短(29.7%),儿童小下巴(38.0%)。体重指数增高、男性性别、改良Mallampati分级3-4、甲状腺距离与面罩通气困难存在显著的统计学关系。结论:体重指数增高的男性患者改良Mallampati分级3-4、甲状腺距离< 6 cm提示面罩通气困难的可能性。在改良Mallampati分类和上唇咬合试验中,随着分类的增加和开口距离的缩短,应考虑喉镜检查困难的可能性。术前评估,包括良好的患者病史和完整的体格检查,对于提供困难气道管理的解决方案至关重要。
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Retrospective Investigation of Difficult Airway Cases Encountered in Bursa Uludag˘ University Medical Faculty Operating Room.

Objective: Ensuring airway patency and proper management of ventilation by anticipating difficulties that can occur in airway control are vital in preventing anaesthesia-related complications. We aimed to determine the role of preoperative assessment findings in difficult airway management.

Methods: In this study, critical incident records of difficult airway patients between 2010 and 2020 in the operating room of Bursa Uludag˘ University Medical Faculty were retrospectively analysed. A total of 613 patients, whose records were fully accessible, were grouped as paediatric (under 18 years old) and adult (18 years and over).

Results: The success rate for maintaining an airway in all patients was 98.7%. Pathological situations which cause difficult airways were head and neck region malignancies in adult patients and congenital syndromes in paediatric patients. Anatomical reasons that cause difficult airway were anterior larynx (31.1%) and short muscular neck (29.7%) in adult patients and small chin (38.0%) in paediatric patients. A significant statistical relationship was found between difficult mask ventilation and increased body mass index, male gender, modified Mallampati class 3-4, and thyromental distance <6 cm (P = .001, P < .001, P < .001, and P < .001, respectively). The correlation of Cormack-Lehane grading with modified Mallampati classification, upper lip bite test, and mouth opening distance was statistically significant (P < .001, P < .001, and P < .001, respectively).

Conclusion: In male patients with increased body mass index, modified Mallampati test class of 3-4 and thyromental distance of < 6 cm should suggest the possibility of difficult mask ventilation. In modified Mallampati classification and upper lip bite tests, the possibility of difficult laryngoscopy should be considered as class increases and mouth opening distance becomes shorter. Preoperative assessment, including a good history taken from the patient and a complete physical examination, is crucial to provide solutions for difficult airway management.

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