阻塞性睡眠呼吸暂停在困难插管患者中的患病率:寻找证据?

M. S. Eldin, A. Yehia, Randa A Abdallah, Gehan Sobhy, M. Abdelaziz
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引用次数: 0

摘要

背景:阻塞性睡眠呼吸暂停和插管困难之间的联系需要充分调查和明确。如果可以预见和管理受损的气道;它可以降低不良后果的可能性。目的:本研究的目的是调查意外困难气管插管患者阻塞性睡眠呼吸暂停的发生率、严重程度和可能的相关性,以及其相关的临床和多导睡眠图结果。方法:将30例气管插管困难后转诊接受检查的患者纳入研究组,同时从睡眠实验室单位数据库中随机选择30例有手术干预史但无气管插管困难的患者作为对照组。通过Muller操作获得办公室临床检查和光纤鼻咽喉喉镜评估的文件。使用改良Mallampati技术对检查的上呼吸道进行临床分级。一夜之间进行了全面的多导睡眠图评估。对麻醉记录中的可用数据以及临床和多导睡眠图检查中的数据进行统计分析,如年龄、性别、体重指数、M Mallampati评分、临床阳性结果、Cormack和Lehane分级、呼吸暂停低通气指数(AHI)、去饱和指数和平均O2%。结果:研究组AHI的平均±SD为(29.7±16.1),对照组为(13.1±9.9),差异有统计学意义(p<0.001),53.3%为重度OSA,其余为中度(26.7%)或轻度OSA(13.3%)。研究组的去饱和指数(28.9±17.4)显著高于对照组(10.2±7.4),而病例中的平均O2%饱和度显著较低(91.8±6.2)。III-CL级病例的平均改良Mallampati评分显著较高,在IV级病例中也有显著性。结论:OSA是气道管理困难的主要风险因素,OSA患者更有可能插管困难。与对照组相比,接受困难插管的患者OSA的发生率和严重程度更高。OSA严重程度和较高的改良Mallampati评分独立相关。
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Prevalence of Obstructive Sleep Apnea in Patients with Difficult Intubation: Looking for Evidence?
BACKGROUND: The link between obstructive sleep apnea and difficult intubation needs to be fully investigated and made clear. If a compromised airway can be anticipated and managed; it can lessen the likelihood of adverse consequences. AIM: The aim of this study was to investigate the incidence, severity, and possible association of obstructive sleep apnea in individuals with unexpected difficult endotracheal intubation and their associated clinical and polysomnographic findings. METHODS: Thirty patients referred for examination after difficult endotracheal intubation were enrolled in the study group, while 30 cases from the sleep laboratory unit database with a history of surgical intervention without difficult intubation were randomly selected for the control group. Documentation was obtained for the office clinical examination and fiber-optic nasopharyngolaryngoscopy assessment by Muller maneuver. The inspected upper airway was graded clinically using the Modified Mallampati technique. A comprehensive polysomnographic assessment was done overnight. The available data from the anesthetic record, as well as those derived from clinical and polysomnographic examination, such as age, sex, Body mass index, M Mallampati score, clinical positive findings, Cormack and Lehane grade, Apnea-Hypopnea Index (AHI), desaturation index, and average O2%, were statistically analyzed. RESULTS: The mean ± SD of the AHI of the study group was (29.7 ± 16.1) while in the control group, it was (13.1 ± 9.9), and the difference was of statistical significance (p < 0.001). The grading of the severity of obstructive sleep apnea (OSA) was significantly different between both groups, with 53.3% of the studied cases having severe OSA and the rest having moderate (26.7%) or mild OSA (13.3%). The desaturation index was significantly higher in the study group (28.9 ± 17.4) than the control group (10.2 ± 7.4), while the average O2% saturation was significantly lower among cases (91.8 ± 6.2). The mean modified Mallampati score was significantly higher among cases with grade III-CL, and the significance was also noticed in class IV. CONCLUSION: OSA is a major risk factor for difficult airway management and OSA patients are more likely to have difficult intubations. Patients who underwent a difficult intubation had a higher incidence and severity of OSA compared to the control group. OSA severity and higher modified Mallampati scores were independently related.
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期刊介绍: Open Access Macedonian Journal of Medical Sciences (OAMJMS) [formerly known as Macedonian Journal of Medical Sciences] is a top-tier open access medical science journal published by the ID Design 2012/DOOEL Skopje, Rajko Zhinzifov No 48, 1000 Skopje, Republic of Macedonia. OAMJMS is an international, modern, general medical journal covering all areas in the medical sciences, from basic studies to large clinical trials and cost-effectiveness analyses. We publish mostly human studies that substantially enhance our understanding of disease epidemiology, etiology, and physiology; the development of prognostic and diagnostic technologies; trials that test the efficacy of specific interventions and those that compare different treatments; and systematic reviews. We aim to promote translation of basic research into clinical investigation, and of clinical evidence into practice. We publish occasional studies in animal models when they report outstanding research findings that are highly clinically relevant. Our audience is the international medical community as well as educators, policy makers, patient advocacy groups, and interested members of the public around the world. OAMJMS is published quarterly online version. The Open Access Macedonian Journal of Medical Sciences (OAMJMS) publishes Medical Informatics, Basic Science, Clinical Science, Case Report, Brief Communication, Public Health, Public Policy, and Review Article from all fields of medicine and related fields. This journal also publishes, continuously or occasionally, the bibliographies of the members of the Society, medical history, medical publications, thesis abstracts, book reviews, reports on meetings, i­n­formation on future meetings, important events and dates, and various headings which contribute to the development of the corresponding scientific field.
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