贵州医科大学 麻醉与心脏电生理课题组
翻译：邓举 编辑：张中伟 审校：曹莹
对于产科人群中插管困难发生率的评估差异较大，尽管以前研究产科插管困难发生率的报告较早，且受样本量较小的限制。本研究的目的是对接受全麻剖宫产女性插管困难和失败的频率提供当代评估，并阐明剖宫产全麻女性插管困难的危险因素。
这是一项利用多中心围手术期结局组数据库进行的多中心、回顾性队列研究。研究对象包括2004年至2019年期间在45家医疗中心中的1家接受剖宫产全身麻醉的15岁至44岁的妇女。主要结果包括插管困难和失败的频率。插管困难定义为喉镜显露分级3级或以上、3次或以上插管尝试、纤维喉镜抢救插管、抢救性声门上气道或气管切开。插管失败则定义为插管时任何尝试都没有将气管插管成功放置。插管困难和插管失败的发生率都会被评估。我们评估了一些患者的人口统计学、解剖学和产科因素与插管困难的潜在关联。
本研究纳入了14,748例在全身麻醉下进行的剖宫产手术。插管困难295例，频率为1：49（95%CI，1：55至1：44；n=14,531）。插管失败18例，频率为1：808（95%CI，1：1276至1：511；n=14,537）。插管困难几率最高的因素包括体重指数增加、马兰帕蒂分级III或IV级、舌骨至颏部的距离小、下颌突出受限、开口受限和颈椎受限。
在这项大型、多中心的当代研究中，我们观察到超过14,000例剖宫产全身麻醉，插管困难的总体风险为1：49，插管失败的风险为1：808。插管困难的危险因素是非产科的。这些数据表明，产科插管困难仍然是一个持续关注的问题。
Sharon C. Reale, Melissa E. Bauer, Thomas T. Klumpner, et al.Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis. [J].Anesthesiology 2022; 136:697–708.
Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis
Abstract
Background: Estimates for the incidence of difficult intubation in the obstetric population vary widely, although previous studies reporting rates of difficult intubation in obstetrics are older and limited by smaller samples. The goals of this study were to provide a contemporary estimate of the frequency of difficult and failed intubation in women undergoing general anesthesia for cesarean delivery and to elucidate risk factors for difficult intubation in women undergoing general anesthesia for cesarean delivery.
Methods: This is a multicenter, retrospective cohort study utilizing the Multicenter Perioperative Outcomes Group database. The study population included women aged 15 to 44 yr undergoing general anesthesia for cesar
ean delivery between 2004 and 2019 at 1 of 45 medical centers. Coprimary outcomes included the frequencies of difficult and failed intubation. Difficult intubation was defined as Cormack–Lehane view of 3 or greater, three or
more intubation attempts, rescue fiberoptic intubation, rescue supraglottic airway, or surgical airway. Failed intubation was defined as any attempt at intubation without successful endotracheal tube placement. The rates of
difficult and failed intubation were assessed. Several patient demographic,anatomical, and obstetric factors were evaluated for potential associations with difficult intubation.
Results: This study identified 14,748 cases of cesarean delivery performed under general anesthesia. There were 295 cases of difficult intubation, with a frequency of 1:49 (95% CI, 1:55 to 1:44; n = 14,531). There were 18 cases
of failed intubation, with a frequency of 1:808 (95% CI, 1:1,276 to 1:511; n =14,537). Factors with the highest point estimates for the odds of difficult intubation included increased body mass index, Mallampati score III or IV, small
hyoid-to-mentum distance, limited jaw protrusion, limited mouth opening, and cervical spine limitations.
Conclusions: In this large, multicenter, contemporary study of more than 14,000 general anesthetics for cesarean delivery, an overall risk of difficult intubation of 1:49 and a risk of failed intubation of 1:808 were observed. Most risk factors for difficult intubation were nonobstetric in nature. These data demonstrate that difficult intubation in obstetrics remains an ongoing concern.
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