急诊困难气管插管的危险因素分析

Risk factors of difficult intubation in the emergency setting

目的评价急诊困难气管插管的预测因子。方法前瞻性研究246例急诊插管患者,气道管理方案适用于所有的急诊气管插管患者。记录患者的一般资料、改良的LEMON评分、Cormack and Lehane分级、成功率及相关并发症,通过多元逻辑回归分析预测困难插管的独立危险因子。结果 248例患者中,第一次插管成功186例(75.0%)为容易插管组,不成功62例(25.0%)为困难插管组。困难插管组中大切牙、大舌头、颏骨至舌骨距离<3指、舌骨至甲状软骨切迹距离<2指、颈部活动困难、肥胖患者和创伤患者的比率显著高于容易插管组(均P<0.05)。多元逻辑回归分析发现舌骨至甲状软骨切迹距离<2指(OR值3.54;95%可信区间1.29～7.23,P=0.007)和大舌头(OR值2.89,95%可信区间0.87～5.98,P=0.048)是困难插管的独立危险因子。Cormack and Lehane分级分级1～4级,级别越高插管越困难。结论改良LEMON评分适合急诊状态下区分困难气管插管,甲状软骨至舌骨的距离<2指和大舌头是急诊预测困难插管的独立危险因子。

Objective To evaluate the risk factors of difficult intubation in the emergency setting.Methods Two hundred and forty-eight patients requiring intubation in the ED were prospective observed.Same airway management protocol was used all intubations.Patients's information,modified LEMON score,Cormack and Lehane classification,success rate,and associated complications were recorded.The independent risk factors in predicting difficult intubation were determined by logistic regression analysis.Results One hundred and eighty-six(75.0%)patients intubated successfully at the first attempt classified in the easy intubation group and the others 62(25.0%)patients in the difficult intubation group.The ratios of large incisors,large tongue,hyoid-to-mental distance less than 3 fingers,thyroid-to-hyoid distance less than 2 fingers,poor neck mobility,obstructed airway,and trauma in the difficult intubation group were significant higher than that in the easy intubation group(without exception,P<0.05).Logistic regression analysis found that thyroid-tohyoid distance less than 2 fingers(odds ratio,3.54;95%confidence interval,1.29-7.23;P=0.007)and large tongue(odds ratio,2.89;95%confidence interval,0.87-5.98;P=0.048)were independent risk factors of complicated intubation.Intubation was more difficult from grade 1 to 4 of Cormack and Lehane classification.Conclusions Modified LEMON score is a useful tool in classifying the difficult intubation in the emergency department.The thyroid-to-hyoid distance less than 2 fingers and large tongue are independent risk factors in predicting difficult intubation in the emergency setting.