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目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者手术麻醉过程中发生困难气道的可预测因素形成原因,以降低该类患者围手术期急性呼吸道梗阻的风险。方法 选择根据夜间多导睡眠监测(PSG)诊断为OSAHS、拟行悬雍垂腭咽成形术(UPPP)、符合病例纳入标准的患者128例,采用快诱导经口插管全身麻醉,记录患者发生困难通气和困难气管插管的情况,对相关临床资料进行统计学处理分析。结果 128例中发生困难面罩通气83例(64.8%),困难插管66例(51.6%)。体质量指数(BMI)、呼吸暂停低通气指数(AHI)、颈围(NC)、腰围(WC)、颈围/身高(NC/H)、腰围/身高(WC/H)、Mallampati气道分级及Cormack-Lehane喉头分级(C-L分级)与困难通气存在相关性;logistic回归分析显示,BMI、NC、Mallampati分级、C-L分级是困难通气的危险因素。BMI、AHI、WC、 WC/H、最低血氧饱和度(LSO2)、上下切牙间距离(ICD)、Mallampati气道分级及C-L分级与困难气管插管存在相关性;AHI、C-L分级是困难气管插管的危险因素,ICD是困难插管的保护性因素。结论 OSAHS患者困难气道发生率较高;颈围、BMI、Mallampati分级、C-L分级是预测困难通气的重要因素;AHI、ICD、C-L分级对困难插管的发生有预测价值
Objective To investigate the formation of predictive factors of difficult airway during surgical anesthesia in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to reduce the risk of perioperative acute respiratory obstruction in these patients. Methods According to nighttime polysomnography (PSG) diagnosed as OSAHS, uvulopalatopharyngoplasty (UPPP) was enrolled in this study. 128 patients were enrolled in this study. The patients were enrolled in this study. Difficult ventilation and difficult tracheal intubation, the relevant clinical data for statistical analysis. Results In 128 cases, 83 cases (64.8%) had difficult mask ventilation and 66 cases (51.6%) had difficult intubation. Body mass index (BMI), AHI, NC, WC, NC / H, WC / H, Mallampati’s airway grading And Cormack-Lehane throat classification (CL grade) were correlated with difficult ventilation. Logistic regression analysis showed that BMI, NC, Mallampati grade and CL grade were the risk factors of difficult ventilation. There was a correlation between BMI, AHI, WC, WC / H, LSO2, ICD, Mallampati classification and CL grade and difficult tracheal intubation; AHI and CL grading were difficult Risk factors for intubation, ICD is a protective factor difficult intubation. Conclusions The incidence of difficult airway in patients with OSAHS is high. Neck circumference, BMI, Mallampati grade and C-L grade are important factors in predicting difficult ventilation. AHI, ICD and C-L grade have predictive value for difficult intubation