阻塞性睡眠呼吸暂停低通气综合征患者气道及下颌骨三维解剖特点与麻醉气管插管

Three-dimensional anatomical characteristics of airway and mandible and anesthetic intubation in patients with obstructive sleep apnea hypopnea syndrome

目的评估阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea hypopnea syndrome,OSAHS)患者气道及下颌骨三维解剖特点与麻醉气管插管方式和次数。方法 收集2014年到2019年期间于我院行全麻手术且已行头颈部螺旋CT扫描的正常气道及OSAHS气道患者各30例,使用Dolphin软件对患者的气道进行三维重建及气道分析,对患者的下颌骨进行三维重建及测量。同时,记录患者麻醉气管插管的方式和次数。结果 OSAHS患者气道的气道体积、气道的矢状向、水平向和冠状向最小横截面积均较正常患者偏低,差异具有统计学意义(P<0.05)。OSAHS患者的下颌距离较正常患者偏低,差异具有统计学意义(P<0.05);下颌角角度与正常患者相比,差异无统计学意义(P>0.05)。OSAHS患者麻醉插管的方式和次数与正常患者相比,差异具有统计学意义(P<0.05)。结论 OSAHS患者气道及下颌骨三维解剖特点存在明显差异,利用气道和下颌骨的解剖学特点进行分析,可为临床全麻前气道评估和气管插管提供参考依据。

Objective To evaluate the three-dimensional anatomical characteristics of airway and mandible,the methods and times of anesthesia intubation in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods 30 patients with normal airway and 30 patients with OSAHS airway who underwent general anesthesia in our hospital and had been scanned by head and neck spiral CT from March 2016 to March 2019 were collected.Dolphin software was used to reconstruct and analyze the airway of the patients.The three-dimensional reconstruction and measurement of the mandible were performed.At the same time,the methods and times of anesthesia intubation were recorded.Results The airway volume,sagittal minimum cross section area,horizontal minimum cross section area and coronal minimum cross section area in OSAHS patients were significantly lower than those in normal patients(P<0.05).The mandibular distance of OSAHS patients was lower than that of normal patients,and the difference was statistically significant(P<0.05),whereas the angle of mandible was not significantly different from that of normal patients(P>0.05).The methods and times of anesthesia intubation in OSAHS patients were significantly different from those in normal patients(P<0.05).Conclusion There are significant differences in three-dimensional anatomical characteristics of airway and mandible in patients with OSAHS.The anatomical characteristics of airway and mandible can be used as a reference for airway evaluation and endotracheal intubation before general anesthesia.