非后仰平卧位视频喉镜插管效果的影响因素分析

Influencing factors for tracheal intubation with video laryngoscope in the supine position without hyperextension of the neck

目的分析视频喉镜用于非后仰平卧位气管插管的影响因素,探索提高气道管理质量的方法。方法选取2017年6月—2018年3月在遵义医科大学附属医院择期全身麻醉下行腹部手术的患者200例,记录可能影响气管插管成功与否、插管时间、术后声音嘶哑的因素,包括患者年龄、身高、体重、气管导管角度及操作者工作年限等一般资料;记录颏甲距离等解剖参数;记录插管时间、手术麻醉时间等手术信息。使用Logistic回归模型分析首次插管失败及术后声音嘶哑发生的影响因素,并以受试者工作特征(ROC)曲线计算气管导管的临界角度。结果插管失败组与插管成功组导管角度、颏甲距离及后仰下颌成角比较,差异有统计学意义(P <0.05)。插管时间<30 s组体重、BMI较插管时间≥30 s组低(P <0.05)。发生声音嘶哑组与未发生声音嘶哑组身高、导管角度比较,差异有统计学意义(P <0.05)。多因素Logistic回归分析显示,颏甲距离[OR=1.588,(95%CI:1.080,2.336)]、导管角度[OR=1.097,(95%CI:1.048,1.148)]是首次尝试气管插管失败的影响因素。导管角度[OR=0.916,(95%CI:0.873,0.961)]是气管插管术后声音嘶哑的影响因素。ROC曲线分析显示,导管角度<78.55°会增加首次插管失败风险;导管角度>84.10°会增加术后声音嘶哑风险。结论在视频喉镜用于非后仰平卧位气管插管中,气管导管角度同时影响插管成功率及术后声音嘶哑发生率;其作为术前可控因素,可能存在潜在最适的气管插管塑性角度。

Objective To analyze the relevant influencing factors for the tracheal intubation with video laryngoscope in the supine position without hyperextension of the neck and to explore the way of enhancing the quality of airway management. Methods We enrolled 200 patients undergoing elective abdominal operation under general anesthesia in our hospital from June 2017 to March 2018, and recorded factors that may affect tracheal intubation success rate, intubation time, and postoperative hoarseness including age, height, and weight of the patients, the bending angle of endotracheal tube and work experience of the operator. Besides, anatomic parameters such as thyromental distance, and surgery information such as intubation and anesthesia time were documented.Logistic regression model was used to analyze the influencing factors for the failure of initial intubation attempt and postoperative hoarseness. Receiver operating characteristic(ROC) curve was applied to calculate the cut-off value of the bending angle of endotracheal tube. Results The bending angle of endotracheal tube, thyromental distance and the angle of head extension were different between the successful intubation group and failed intubation group(P <0.05). The weight and body mass index of the patients in the group with intubation time less than 30 s were lower than those in the group with intubation time no less than 30 s(P < 0.05). The weight of the patients, the bending angle of endotracheal tube and the success rate of initial intubation attempt were different between the group with and without postoperative hoarseness(P < 0.05). Multivariate Logistic regression analysis suggested that thyromental distance [OR = 1.588(95% CI: 1.080, 2.336)] and the bending angle of endotracheal tube [OR= 1.097(95% CI: 1.048, 1.148)] were influencing factors for the failure of initial intubation attempt, and that the bending angle of endotracheal tube [ OR= 0.916(95% CI: 0.873, 0.961)] was an influencing factor for postoperative hoarseness. ROC analysis showed that the bending angle of endotracheal tube less than 78.55° would increase the risk of failure in the first attempt to intubation, while that greater than 84.10° would increase the risk of postoperative hoarseness. Conclusions In tracheal intubation with video laryngoscope in the supine position without hyperextension of the neck, the bending angle of the endotracheal tube affected both the success rate of intubation and the incidence of postoperative hoarseness. The bending angle of endotracheal tube between 78.55° to 84.10°may be potentially optimal and could be recommended for clinical use.