强直性脊柱炎困难气道患者光棒插管失败因素分析

Analysis of failure factors of lightwand intubation in patients with ankylosing spondylitis

目的探讨强直性脊柱炎（ankylosingspondylitis，AS）困难气道患者行光棒气管插管失败的相关因素。方法回顾性分析60例曾进行光棒气管插管的As患者的病历资料，其中42例光棒插管成功，18例光棒插管失败。收集As患者与困难气道相关的临床资料：BMI、张El度、甲颏间距、全脊柱后凸最大角（globalkyphosis，GK）、颈椎活动度（cervicalrangeofmotion，CROM）、颈椎曲度。根据光棒插管的结果分为成功组（A组，42例）、失败组（B组，18例），比较两组患者上述气道相关参数的差异性，对于有差异的参数采用Logisic回归分析其与光棒插管失败的相关性，寻找As患者不宜使用光棒气管插管的可能因素。结果B组患者的甲颏间距、颈椎曲度明显小于A组（P〈0．05），两组BMI、张口度、CROM、GK差异无统计学意义（P〉0．05）。Logisic回归分析提示颈椎曲度的改变是As患者光棒气管插管失败的可能因素。结论颈椎正常生理曲度丢失严重、局部前倾程度严重的AS患者不宜采用光棒插管。

Objective To analyze the failure factors of lightwand intubation in patients with ankylosing spondylitis （AS）. Methods The clinical data of sixty AS patients underwent lightwand tracheal intubation of which forty-two cases of successful intubation, eighteen cases of failed intubation were retrospectively analyzed. The following data were recorded： IBM, interincisor gap, thyromental distance, global kyphosis （GK）, cervical range of motion （CROM）, cervical curve. According to the results of intubation, patients were divided into two groups： success group （group A, n=42） and failure group （group B, n=18）. The differences of parameters between the two groups were compared. Furthermore, the logistic regression analysis was performed to investigate the risk factors correlated with lightwand tracheal intubation failure. Results Compared with group A, thyromental distance and cervical curve were statistically lower in group B （P〈0.05）, in contrast, BMI, interincisor gap, GK and CROM had no statistically significant difference. Logistic regression analysis indicated that cervical curve （OR=0.39, P=0.005） was independent risk factor of lightewand tracheal intubation failure. Conclusions AS patients with cervical imaging and local forward, lightwand tracheal intubation is not a suitable method being used.