全麻术后环杓关节脱位预后因素的初步分析

Preliminary Analysis on Prognostic Factors of Arytenoid Dislocation After General Anesthesia

目的探讨全麻术后环杓关节脱位的预后因素。方法回顾性分析2017年1月~2020年12月我院16153例接受全麻的临床资料,发生环杓关节脱位17例(病例组),采用巢式病例对照研究方法,按1∶6匹配同期同类未发生环杓关节脱位的102例作为对照组,单因素分析BMI、气道评估异常、贫血、甲亢、术前留置胃管、插管方式(清醒/诱导后)、可视硬镜插管、非一次性插管成功、插管时呛咳、拔管时呛咳、手术间带管时间、术后ICU带管时间超过1 d这些因素。结果单因素分析提示气道评估异常、贫血、可视硬镜插管、非一次性插管成功、拔管时呛咳、术后ICU带管时间超过1 d可能与术后环杓关节脱位有关(P<0.05)。结论环杓关节脱位是全麻术后严重并发症,患者气道评估异常、术前的贫血状态未予纠正、使用可视硬镜插管、插管技术不熟练、麻醉苏醒期拔管时呛咳、术后ICU带管时间超过1 d可能是全麻后环杓关节脱位的预后因素。

Objective To explore the prognostic factors of arytenoid dislocation in patients after general anesthesia.Methods A retrospective analysis was performed on 16153 patients registered in our hospital undergoing general anesthesia from January 2017 to December 2020.Postoperative arytenoid dislocation occurred in 17 patients(study group).According to the nested case-control study,102 cases of the same kind without arytenoid dislocation in the same period were matched at a ratio of 1∶6 as the control group.Univariate analysis was made on body mass index(BMI),estimated difficult airway,anemia,hyperthyroidism,preoperative indwelling of gastric tube,intubation method(after awake/induction),visible rigid tracheoscopy for endotracheal tube insertion,non one-time intubation success,choking during intubation,choking during extubation,time of intubation in the operation room,and time of ICU intubation more than 1 day.Results There were significant differences in factors including estimated difficult airway,anemia,visible rigid tracheoscopy for endotracheal tube insertion,non one-time intubation success,choking during extubation,and time of ICU intubation more than 1 day according to univariate analysis(P<0.05).Conclusions Arytenoid dislocation is a serious complication after general anesthesia.Estimated difficult airway,uncontrolled preoperative anemia,visible rigid tracheoscopy for tube insertion,unskilled performance in tube insertion,choking during extubation in recovery period,and duration of ICU intubation more than 1 day after anesthesia are prognostic factors.