低BMI是气管内插管引起的环杓关节脱位的独立危险因素—回顾性病例对照研究

发布时间：2018-05-10 16:59

  本文选题：环杓关节脱位 + 体质指数　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:评估全麻气管内插管引起的环杓关节脱位的危险因素。方法:回顾性分析浙江大学医学院附属第二医院自2014年9月至2016年9月期间,在我院全麻气管内插管术后出现环杓环节脱位28例患者的临床资料。对照组选择了与28例手术方式与麻醉方式相同的患者56例(以1:2配对)。分析的危险因素包含:个人基本情况(性别、年龄、身高、体重)、吸烟状态、饮酒状态、手术持续时间及麻醉相关因素(气管导管管径、气管导管类型、插管次数、操作者经验以及插管辅助工具)。环杓关节脱位患者诊断依据病史、喉镜检查、咽喉部高分辨率CT检查,以及基于CT图像的环杓关节三维重建。统计方法中,二分类变量用频率与百分数表示,卡方检验对两组数据进行统计比较;连续性变量用平均数±标准差表示,采用独立样本的T检验进行数据统计;使用logistic回归模型进行多因素分析,筛查独立的危险因素,以P0.05表明统计显著性。结果:28例气管内插管引起的环杓关节脱位患者中,男18例,女10例,平均年龄55岁。左侧环杓关节脱位16例(57.14%,16/28),右侧环杓关节脱位12例(42.86%,12/28),左、右侧脱位无明显统计学差异(P0.05)。单因素分析结果提示年龄(P=0.567)、性别(P=0.568)、手术时间(P=0.179)、吸烟状态(P=0.399)以及饮酒状态(P=0.104)与气管内插管引起的环杓关节脱位的发生率无明显相关性。气管导管管径(p=0.473)、气管导管类型(P=1.000)、插管次数(P=0.110)、操作者经验(P=0.202)及插管辅助工具(P=0.536)上二组之间无明显统计学差异。BMI(体质指数)与环杓关节脱位相关(P0.01)。logistic回归分析表明低BMI是气管内插管引起的环杓关节脱位的独立危险因素(P=0.048)。男性BMI低于21.5 kg/m2组较大于和/或等于21.5 kg/m2组环杓关节脱位的发生有统计学差异(P=0.041);女性BMI低于20.5 kg/m2组较大于和/或等于20.5 kg/m2组环杓关节脱位的发生有统计学差异(P=0.043)。结论:1、低BMI是气管内插管引起的环杓关节脱位的独立危险因素,BMI低于21.5 kg/m2的男性和BMI低于20.5 kg/m2的女性行全麻气管内插管较易发生环杓关节脱位。2、基于CT扫描图像的环杓关节三维重建,可有效鉴别环杓关节脱位与声带麻痹。3、表麻下行闭合复位术是一种有效且安全的治疗手段。
[Abstract]:Objective: to evaluate the risk factors of cricoarytenoid joint dislocation caused by endotracheal intubation under general anesthesia. Methods: the clinical data of 28 patients with cricoarytenoid dislocation after endotracheal intubation under general anesthesia were retrospectively analyzed in the second affiliated Hospital of Zhejiang University Medical College from September 2014 to September 2016. The control group selected 56 patients who had the same operation and anesthesia as 28 patients (1:2 pairing). The risk factors analyzed included: individual basic conditions (sex, age, height, weight, smoking status, alcohol consumption, duration of operation, and anaesthesia related factors (tracheal duct diameter, tracheal duct type, intubation frequency, etc.) Operator experience and intubation aids. The diagnosis of cricoarytenoid dislocation was based on history laryngoscopy high resolution CT examination of pharynx and 3D reconstruction of cricoarytenoid joint based on CT images. In the statistical method, the two kinds of variables are expressed as frequency and percentage, the chi-square test is used to compare the two groups of data, the continuous variable is represented by the mean 卤standard deviation, and the independent sample T-test is used to carry out the statistics. The logistic regression model was used for multivariate analysis to screen independent risk factors, which was statistically significant (P0.05). Results of 28 patients with cricoarytenoid dislocation caused by endotracheal intubation, 18 were male and 10 female, with an average age of 55 years. There were 16 cases of left cricoarytenoid dislocation (57.14%) and 12 cases of right cricoarytenoid dislocation (12 cases). There was no significant difference between left and right dislocation (P 0.05). Univariate analysis showed that there was no significant correlation between the incidence of cricoarytenoid joint dislocation caused by endotracheal intubation, age, sex, time of operation, smoking status, alcohol consumption, and the incidence of cricoarytenoid joint dislocation caused by endotracheal intubation, the results of univariate analysis showed that there was no significant correlation between the age group and the incidence of cricoarytenoid joint dislocation caused by endotracheal intubation. There was no significant statistical difference between the two groups in tracheal duct diameter, tracheal duct type, tracheal tube type, intubation frequency and operator's experience (P0. 202) and intubation assistant tool P0. 536) there was no significant statistical difference between the two groups. BMI (BMI) was correlated with cricoarytenoid dislocation (P0. 01. Logistic regression analysis showed that low BMI was found in the two groups. It is an independent risk factor of cricoarytenoid joint dislocation caused by endotracheal intubation. There was significant difference in the occurrence of cricoarytenoid dislocation in male patients with BMI lower than 21.5 kg/m2 than and / or equal to 21.5 kg/m2, and the incidence of cricoarytenoid dislocation in females lower than 20.5 kg/m2 was greater than and / or equal to 20.5 kg/m2. There was significant difference in the occurrence of cricoarytenoid dislocation between male and / or equal 21.5 kg/m2 groups (P < 0.043). Conclusion low BMI is an independent risk factor for cricoarytenoid joint dislocation caused by endotracheal intubation. Men with BMI lower than 21.5 kg/m2 and women with BMI less than 20.5 kg/m2 are more likely to have dislocation of cricoarytenoid joint after endotracheal intubation under general anesthesia, based on CT scan. Three dimensional reconstruction of the cricoarytenoid joint, It can effectively distinguish cricoarytenoid joint dislocation from vocal cord paralysis. Closed reduction under epigastric anesthesia is an effective and safe treatment.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
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本文编号：1870123