先天性多发性关节挛缩症伴脊柱侧凸患者气道管理

Management of airway for scoliosis patients associated with arthrogryposis multiplex congenita

目的总结先天性多发性关节挛缩症（arthrogryposismultiplexcongenita，AMC）伴脊柱侧凸患者气道管理的经验。方法回顾分析行脊柱矫形手术的20例AMC伴脊柱侧凸患者的病历资料。12例（60％）男性患者，8例（40％）女性患者。患者平均年龄（14．9±3．7）岁。术前Cobb角中位数为90°，最大值为147°。记录患者的Mallampati评分、肺通气功能状态、是否为困难气道及使用特殊的插管工具情况、术后是否转入重症监护室（intensivecareunit，ICU）、拔管时间。结果20例患者中，Mallampati评分Ⅰ级3例（15％），Ⅱ级9例（45％），Ⅲ级5例（25％），Ⅳ级3例（15％）.均存在不同程度的肺通气功能障碍，其中轻度1例（5％），中度4例（20％），重度15例（75％）。5例诊断为困难气道的患者，通过纤维支气管镜引导下气管内插管成功。术后7例患者因肺通气功能障碍导致拔管困难而转入ICU。术后最短拔管时间为10min，最长达1115min。结论麻醉医师术前访视应充分评估AMC伴脊柱侧凸患者的气道情况。重点评估是否为困难气道，尤其是否有气管内插管困难的情况。

Objective To summarize the experience of management of airway in scoliosis patients associated with arthrogryposis multiplex eongenita （AMC）. Methods The medical records of twenty scoliosis patients associated with AMC undergoing spinal corrective surgery in our hospital were retrospectively reviewed. There were twelve male patients and eight female patients in our study. The age of patients averaged at （ 14.9±3.7 ） years, ranging from 9 to 24 years. The median degree of preoperative Cobb angle was 90 degrees, with the maximum Cobb angle of 147 degrees. The following data were recorded： the grade of Mallampati, the results of pulmonary function tests, whether it was difficult airway or not, the special instrument for intubation, whether it was admitted to intensive care unit （ICU） or not after surgery, and the time from end of surgery to tracheal extubation. Results The cases of Mallampati Ⅰ , Ⅱ , Ⅲ, and Ⅳ grade was 3（15%）, 9（45%）, 5（25%）, and 3（15%）, respectively. All patients suffered from pulmonary dysfunction. The cases of mild, moderate and severe preoperative pulmonary dysfunction was 1 （5%）, 4 （20%） and 15 （75%）, respectively. Five patients with anticipated difficult airway were successfully intubated via fiber bronchoseope. After surgery, seven patients with difficult tracheal extubation caused by lung ventilation dysfunction were admitted to ICU to monitor vital signs closely. The time from end of surgery to tracheal extubation varied greatly, ranging from 10 min to 1 115 rain. Conclusions The patient＇s airway should be thoroughly examined by the attending anesthesiologists during preoperative interview, whose attention should be focused on assessing difficult airway, especially for difficult intubation. The anesthetists should make well preparations for difficult airway, especially for difficult intubation, including emergency drugs, and special instruments for intubation.