综述

阻塞性睡眠呼吸暂停综合征患者困难气道评估的研究

  • 黄佳 ,
  • 黄浩贤 ,
  • 陆立基 ,
  • 盛恒炜
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  • 1.佛山市三水区人民医院,耳鼻喉科,(广东 佛山 528100 )
    2.佛山市三水区人民医院,麻醉科,(广东 佛山 528100 )
    3.佛山市中医院麻醉科 (广东 佛山 528100 )

收稿日期: 2023-10-25

  网络出版日期: 2024-05-21

基金资助

广东省医院药学研究基金(2020XC36);佛山市卫生健康局医学科研课题立项(20240720A010237)

Research of difficult airway assessment in patients with obstructive sleep apnea hypopnea syndrome

  • Jia HUANG ,
  • Haoxian HUANG ,
  • Liji LU ,
  • Hengwei. SHENG
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  • *.Department of Anesthesiology,Sanshui District People's Hospital,Foshan 528100,China

Received date: 2023-10-25

  Online published: 2024-05-21

摘要

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea hypopnea syndrome, OSAS)是常见的睡眠呼吸障碍疾病,易导致上呼吸道狭窄、舌体后坠、低氧血症等解剖及生理的改变。OSAS是引发麻醉困难插管的常见原因之一,准确评估此群体的困难气道对预防围术期不良事件发生有重要意义。目前困难气道的评估手段多样,评价不一,本文就OSAS困难气道的各类评估方法进行综述,总结困难气道预测的新趋势,帮助麻醉医师进行准确的术前评估。

本文引用格式

黄佳 , 黄浩贤 , 陆立基 , 盛恒炜 . 阻塞性睡眠呼吸暂停综合征患者困难气道评估的研究[J]. 实用医学杂志, 2024 , 40(10) : 1460 -1466 . DOI: 10.3969/j.issn.1006-5725.2024.10.023

Abstract

Obstructive sleep apnea hypopnea syndrome (OSAS) is a disease characterized by intermittent complete or partial upper airway obstruction accompanied by hypoxemia during sleep and is a common cause of difficult intubation. Patients with confirmed or highly suspected OSAS are usually at higher risk for difficult airways. Prediction of difficult airway in OSAS patients is of great significance to prevent perioperative adverse events. The current assessment tools for difficult airways are varied and evaluated inconsistently. In this article, we provide an overview of the various types of predictors of difficult intubation in OSAS and summarize the new trends in the prediction of difficult intubation to help anesthesiologists make accurate preoperative assessments.

参考文献

1 潘悦达, 王东博, 韩德民. 我国成人阻塞性睡眠呼吸暂停低通气综合征患病率的Meta分析[J]. 医学信息, 2019, 32(7): 73-77+81. doi:10.3969/j.issn.1006-1959.2019.07.022
2 MEMTSOUDIS S G, COZOWICZ C, NAGAPPA M, et al. Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients with Obstructive Sleep Apnea[J]. Anesth Analg, 2018, 127(4): 967-987. doi:10.1213/ane.0000000000003434
3 NUCKTON T J, GLIDDEN D V, BROWNER W S, et al. Physical Examination: Mallampati Score as an Independent Predictor of Obstructive Sleep Apnea[J]. Sleep, 2006, 29(7): 903-908. doi:10.1093/sleep/29.7.903
4 STUTZ E W, RONDEAU B. Mallampati Score [M]. Treasure Island (FL): StatPearls Publishing, 2023.
5 HEALY D W, LAHART E J, PEOPLES E E, et al. A Comparison of the Mallampati evaluation in neutral or extended cervical spine positions: a retrospective observational study of >80 000 patients[J]. Br J Anaesth, 2016, 116(5): 690-698. doi:10.1093/bja/aew056
6 MARKOS Z, MELESE E, GETACHEW L, et al. Comparison of Mallampati test in sitting position and in supine position for prediction of difficult tracheal intubation among adult patients who underwent surgery under general anesthesia at Addis Ababa governmental hospitals 2021, comparative cross-sectional study[J]. Ann Med Surg (Lond), 2022, 82: 104711. doi:10.1016/j.amsu.2022.104711
7 OUCHI K, HOSOKAWA R, YAMANAKA H, et al. Mallampati test with phonation, tongue protrusion and supine position is most correlated with Cormack-Lehane test[J]. Odontology, 2020, 108(4): 617-625. doi:10.1007/s10266-020-00490-3
8 HARJAI M, ALAM S, BHASKAR P. Clinical Relevance of Mallampati Grading in Predicting Difficult Intubation in the Era of Various New Clinical Predictors[J]. Cureus, 2021, 13(7): e16396.
9 YEMAM D, MELESE E, ASHEBIR Z. Comparison of modified mallampati classification with Cormack and Lehane grading in predicting difficult laryngoscopy among elective surgical patients who took general anesthesia in Werabie comprehensive specialized hospital-Cross sectional study. Ethiopia, 2021[J]. Ann Med Surg (Lond), 2022, 79: 103912. doi:10.1016/j.amsu.2022.103912
10 PATEL B, KHANDEKAR R, DIWAN R, et al. Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults[J]. Indian J Anaesth, 2014, 58(2): 171-175. doi:10.4103/0019-5049.130821
11 MAHMOODPOOR A, SOLEIMANPOUR H, GOLZARI S E, et al. Determination of the diagnostic value of the Modified Mallampati Score, Upper Lip Bite Test and Facial Angle in predicting difficult intubation: A prospective descriptive study[J]. J Clin Anesth, 2017, 37: 99-102. doi:10.1016/j.jclinane.2016.12.010
12 DE CARVALHO C í C, SILVA D M DA, LEITE M S, et al. Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholds[J]. Braz J Anesthesiol, 2022, 72(6): 736-741. doi:10.1016/j.bjane.2021.09.008
13 KHETERPAL S, HAN R, TREMPER K K, et al. Incidence and Predictors of Difficult and Impossible Mask Ventilation[J]. Anesthesiology, 2006, 105(5): 885-891. doi:10.1097/00000542-200611000-00007
14 HIREMATH A S, HILLMAN D R, JAMES A L, et al. Relationship between difficult tracheal intubation and obstructive sleep apnoea[J]. Br J Anaesth, 1998, 80(5): 606-611. doi:10.1093/bja/80.5.606
15 KIM J A, LEE J J. Preoperative predictors of difficult intubation in patients with obstructive sleep apnea syndrome[J]. Can J Anaesth, 2006, 53(4): 393-397. doi:10.1007/bf03022506
16 NAGAPPA M, WONG D T, COZOWICZ C, et al. Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies[J]. PLoS One, 2018, 13(10): e0204904. doi:10.1371/journal.pone.0204904
17 SEET E, CHUNG F, WANG C Y, et al. Association of Obstructive Sleep Apnea with Difficult Intubation: Prospective Multicenter Observational Cohort Study[J]. Anesth Analg, 2021, 133(1): 196-204. doi:10.1213/ane.0000000000005479
18 SIYAM M A, BENHAMOU D. Difficult Endotracheal Intubation in Patients with Sleep Apnea Syndrome[J]. Anesth Analg, 2002, 95(4): 1098-1102. doi:10.1213/00000539-200210000-00058
19 CHUNG F, ABDULLAH H R, LIAO P. STOP-Bang Questionnaire[J]. Chest, 2016, 149(3): 631-638. doi:10.1378/chest.15-0903
20 TOSHNIWAL G, MCKELVEY G M, WANG H. STOP-Bang and prediction of difficult airway in obese patients[J]. J Clin Anesth, 2014, 26(5): 360-367. doi:10.1016/j.jclinane.2014.01.010
21 CHUNG F, YEGNESWARAN B, LIAO P, et al. STOP Questionnaire[J]. Anesthesiology, 2008, 108(5): 812-821. doi:10.1097/aln.0b013e31816d83e4
22 井凤云, 王 军, 郭向阳. 困难气道评估的临床应用进展[J]. 中国微创外科杂志, 2019, 19(4): 363-366. doi:10.3969/j.issn.1009-6604.2019.04.018
23 XU M, LI X X, WANG J, et al. Application of a new combined model including radiological indicators to predict difficult airway in patients undergojking surgery for cervical spondylosis[J]. Chin Med J (Engl), 2014, 127(23): 4043-4048. doi:10.3760/cma.j.issn.0366-6999.20141345
24 KHAN Z, ARBABI S. Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head and neck landmarks obtained from lateral neck X-ray[J]. Indian J Anaesth, 2013, 57(4): 381. doi:10.4103/0019-5049.118567
25 LIU X, FLANAGAN C, FANG J, et al. Comparative analysis of popular predictors for difficult laryngoscopy using hybrid intelligent detection methods[J]. Heliyon, 2022, 8(11): e11761. doi:10.1016/j.heliyon.2022.e11761
26 耿清胜, 朱也森. 上气道CT三维重建图像评估困难气道的可行性研究[J]. 中国口腔颌面外科杂志,2006, 4(5): 352-355. doi:10.3969/j.issn.1672-3244.2006.05.008
27 CHEN W, MA L, SHAO J, et al. Morphological specificity analysis of an image-based 3D model of airway filling in a difficult airway[J]. BMC Anesthesiology, 2022, 22(1): 336. doi:10.1186/s12871-022-01880-6
28 KOVATCH K J, POWELL A R, GREEN K, et al. Development and Multidisciplinary Preliminary Validation of a 3-Dimensional-Printed Pediatric Airway Model for Emergency Airway Front-of-Neck Access Procedures[J]. Anesth Analg, 2020, 130(2): 445-451. doi:10.1213/ane.0000000000003774
29 TACHIBANA N, NIIYAMA Y, YAMAKAGE M. Incidence of cannot intubate-cannot ventilate (CICV): results of a 3-year retrospective multicenter clinical study in a network of university hospitals[J]. J Anesth, 2015, 29(3): 326-330. doi:10.1007/s00540-014-1847-1
30 ANDRUSZKIEWICZ P, WOJTCZAK J, SOBCZYK D, et al. Effectiveness and Validity of Sonograph-ic Upper Airway Evaluation to Predict Difficult Laryngoscopy[J]. J Ultrasound Med, 2016, 35(10): 2243-2252. doi:10.7863/ultra.15.11098
31 SOTOODEHNIA M, KHODAYAR M, JALALI A, et al. Prediction of difficult laryngoscopy/difficult intubation cases using upper airway ultrasound measurements in emergency department: a prospective observational study[J]. BMC Emerg Med, 2023, 23(1): 78. doi:10.1186/s12873-023-00852-4
32 ACETO P, MODESTI C, PERILLI V, et al. A new score which includes ultrasound-assessed tongue thickness to predict difficult intubation in morbidly obese patients: A prospective observational cohort study[J]. Eur J Anaesthesiol, 2022, 39(4): 388-390. doi:10.1097/eja.0000000000001518
33 DATE A, BHANUSHALI A. Evaluation of upper lip bite test and thyromental height test for prediction of difficult laryngoscopy: A prospective observational study[J]. Airway, 2021, 4(3): 185. doi:10.4103/arwy.arwy_48_21
34 SELVI O, KAHRAMAN T, SENTURK O, et al. Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study[J]. J Clin Anesth, 2017, 36: 21-26. doi:10.1016/j.jclinane.2016.08.006
35 KHAN Z H, KASHFI A, EBRAHIMKHANI E. A Comparison of the Upper Lip Bite Test (a Simple New Technique) with Modified Mallampati Classification in Predicting Difficulty in Endotracheal Intubation: A Prospective Blinded Study[J]. Anesth Analg, 2003, 96(2): 595-599. doi:10.1213/00000539-200302000-00053
36 HONARMAND A, SAFAVI M, ANSARI N. A comparison of between hyomental distance ratios, ratio of height to thyromental, modified Mallamapati classification test and upper lip bite test in predicting difficult laryngoscopy of patients undergoing general anesthesia[J]. Adv Biomed Res, 2014, 3: 166. doi:10.4103/2277-9175.139130
37 IOI H, NAKATA S, NAKASIMA A, et al. Comparison of cephalometric norms between Japanese and Caucasian adults in antero-posterior and vertical dimension[J]. Eur J Orthod, 2007, 29(5): 493-499. doi:10.1093/ejo/cjm059
38 MIYAJIMA K, MCNAMARA J A, KIMURA T, et al. Craniofacial structure of Japanese and European-American adults with normal occlusions and well-balanced faces[J]. Am J Orthod Dentofacial Orthop, 1996, 110(4): 431-438. doi:10.1016/s0889-5406(96)70047-1
39 CHANG H P, LIU P H, TSENG Y C, et al. Morphometric analysis of the cranial base in Asians[J]. Odontology, 2014, 102(1): 81-88. doi:10.1007/s10266-012-0096-8
40 KIM J C, KI Y, KIM J, et al. Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans[J]. BMC Anesthesiol, 2019, 19(1): 9. doi:10.1186/s12871-018-0675-5
41 张鹏, 张华, 胡扬喜, 等. 中国人内脏脂肪指数与肥胖合并阻塞性睡眠呼吸暂停的相关性及预测价值. [J]. 实用医学杂志, 2023, 39(17): 2210-2214. doi:10.3969/j.issn.1006-5725.2023.17.010
42 EZRI T, GEWüRTZ G, SESSLER D I, et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue [J]. Anaesthesia, 2003, 58(11): 1111-1114. doi:10.1046/j.1365-2044.2003.03412.x
43 ABDEL NAIM H E, MOHAMED S A R, SOAIDA S M, et al. The importance of neck circumference to thyromental distance ratio (NC/TM) as a predictor of difficult intubation in obstructive sleep apnea (OSA) patients[J]. Egy J Anaesth, 2014, 30(3): 219-225. doi:10.1016/j.egja.2014.03.002
44 KIM W H, AHN H J, LEE C J, et al. Neck circumference to thyromental distance ratio: a new predictor of difficult intubation in obese patients[J]. Br J Anaesth, 2011, 106(5): 743-748. doi:10.1093/bja/aer024
45 L′HERMITE J, NOUVELLON E, CUVILLON P, et al. The Simplified Predictive Intubation Difficulty Score: a new weighted score for difficult airway assessment[J]. Eur J Anaesthesiol, 2009, 26(12): 1003-1009. doi:10.1097/eja.0b013e32832efc71
46 SHAH P, DUBEY K, YADAV J. Predictive value of upper lip bite test and ratio of height to thyromental distance compared to other multivariate airway assessment tests for difficult laryngoscopy in apparently normal patients[J]. J Anaesthesiol Clin Pharmacol, 2013, 29(2): 191. doi:10.4103/0970-9185.111700
47 KROBBUABAN B, DIREGPOKE S, KUMKEAW S, et al. The Predictive Value of the Height Ratio and Thyromental Distance: Four Predictive Tests for Difficult Laryngoscopy[J]. Anesth Analg, 2005, 101(5): 1542-1545. doi:10.1213/01.ane.0000181000.43971.1e
48 ETEZADI F, AHANGARI A, SHOKRI H, et al. Thyromental Height: A New Clinical Test for Prediction of Difficult Laryngoscopy[J]. Anesth Analg, 2013, 117(6): 1347-1351. doi:10.1213/ane.0b013e3182a8c734
49 LANGERON O, CUVILLON P, IBANEZ-ESTEVE C, et al. Prediction of Difficult Tracheal Intubation[J]. Anesthesiology, 2012, 117(6): 1223-1233. doi:10.1097/aln.0b013e31827537cb
50 NAGUIB M, SCAMMAN F L, O'SULLIVAN C, et al. Predictive Performance of Three Multivariate Difficult Tracheal Intubation Models: A Double-Blind, Case-Controlled Study[J]. Anesth Analg, 2006, 102(3): 818-824. doi:10.1213/01.ane.0000196507.19771.b2
51 EL-GANZOURI A R, MCCARTHY R J, TUMAN K J, et al. Preoperative Airway Assessment: Predictive Value of a Multivariate Risk Index[J]. Anesth Analg, 1996, 82(6): 1197-1204. doi:10.1213/00000539-199606000-00017
52 BICALHO G P, BESSA Jr. R C, CRUVINEL M G C, et al. A prospective validation and comparison of three multivariate models for prediction of difficult intubation in adult patients[J]. Braz J Anesthesiol, 2023, 73(2): 153-158. doi:10.1016/j.bjane.2021.07.028
53 ZHOU C M, XUE Q, YE H T, et al. Constructing a prediction model for difficult intubation of obese patients based on machine learning[J]. J Clin Anesth, 2021, 72: 110278. doi:10.1016/j.jclinane.2021.110278
54 ZANG Q, CUI H, GUO X, et al. Clinical value of video-assisted single-lumen endotracheal intubation and application of artificial intelligence in it[J]. Am J Transl Res, 2022,14(11):7643-7652.
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