分娩前后的气道变化对改良的mallampati评分有影响吗?

A. Das, N. Sabharwal, M. Kumar
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引用次数: 1

摘要

背景:由于各种原因,改良mallampati分级随着妊娠、分娩和分娩的进展而发生变化。这可能会导致气道管理出现意想不到的困难,尤其是如果产妇在产后接受手术。本研究旨在评估腰麻下段剖宫产产妇分娩后气道参数的变化。材料和方法:本研究在Vardhaman Mahavir(VMMC)和Safdarjung医院进行,为期18个月。共有160名患者在脊柱麻醉下接受选择性或紧急剖宫产手术(每组80名)。在剖宫产前(T1)和分娩后2小时(T2)、6小时(T3)、24小时(T4)、48小时(T5)和72小时(T6)的不同时间间隔测量气道参数,包括改良mallampati分级(MMPG),并进行统计学分析。结果:急诊组有71.25%的病例发生MMPG变化,而择期组有40%的病例发生变化(P=0.0001)。急诊组在LSCS后2小时至72小时的平均MMPG显著升高(有更多的患者在积极分娩)。(P=0.0001)。两组MMPG的最大变化发生在分娩后6小时。择期患者MMPG正常化至术前值的时间较早(P=0.0005)。分娩持续时间与MMPG变化正常化至手术前值之间存在相关性(P=0.023)。因此,分娩后应重新评估母亲的气道,以便进行任何手术。
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Airway changes before & after delivery-does labour has any effect on the modified mallampati score?
Background: Changes in modified mallampati grade occur with the progress of pregnancy, labor, and delivery due to various reasons. This could lead to unanticipated difficulties in airway management, especially if the parturient were to undergo a surgical procedure in the postpartum period. Our study aimed to evaluate the change in airway parameters after delivery in parturient undergoing lower segment cesarean section (LSCS) under spinal anesthesia. Materials and Methods: This study was conducted at Vardhaman Mahavir (VMMC) and Safdarjung Hospital over a period of 18 months. A total of 160 patients posted for either elective or emergency cesarean section under spinal anesthesia were enrolled in the study (80 in each group). Airway parameters including modified mallampati grade (MMPG) were measured at various time intervals – before cesarean section (T1) and 2 h (T2), 6 h (T3), 24 h (T4), 48 h (T5), and 72 h (T6) after delivery and analyzed statistically. Results: Changes in MMPG occurred in 71.25% of cases in the emergency group as compared with 40% of cases in the elective group (P = 0.0001). The mean MMPG was significantly higher from 2 h up to 72 h after LSCS in the emergency group (having more patients in active labor). (P = 0.0001). Maximum changes in MMPG occurred 6 h after delivery in both groups. Normalization of MMPG to its precesarean value occurred earlier in elective patients (P = 0.0005). An association was found between the duration of labor and normalization of changes in MMPG to its preoperative value (P = 0.023). Conclusion: Airway changes in pregnant women are seen to worsen after emergency LSCS under spinal anesthesia and are affected by prolonged labor. Therefore, the maternal airway should be reassessed after the delivery of the baby, for any surgical procedure thereafter.
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