全麻支撑喉镜下声门暴露困难的相关因素

目的：探讨预测支撑喉镜显微手术声门暴露困难的危险因素,为术前评估提供参考。方法：将89例声带疾病（包括声带息肉、声带小结、喉癌、喉部乳头状瘤等）接受过支撑喉镜手术的患者分为声带暴露困难组和对照组。通过收集患者的性别、年龄;测量患者的一般资料,包括身高、体重及BMI、颈周长、舌背高度评估,分别于体表及头颈侧位X线片下测量每位患者自然位及仰伸位时的舌骨下颌骨颏下角距离、甲状软骨上切迹与下颌骨颏下角距离、胸骨上窝至颏下角距离、甲状软骨上切迹与舌骨的垂直距离。建立数据库,结合患者支撑喉镜术中声门区暴露的情况对上述影响因素进行统计学分析。结果：单因素分析显示BMI、颈围、mallampati指数、HMD、TMD、SMD与术中声门区暴露相关,差异有统计学意义（P〈0.05）。经多因素统计分析,颈围大于40cm,HMD、SMD分别小于6.05cm和13.9cm与术中声门区暴露相关,差异有统计学意义（P〈0.05）。结论：患者头颈部解剖特点影响支撑喉镜下声门区的暴露,术前可根据相关参数预测声门区暴露情况。

Related Factors of Difficult Laryngeal Exposure in Suspension Laryngoscopy under General Anesthesia

Objective：To explore the risk factors those affect the exposure of glottis in suspension laryngoscopy. Methods： 89 patients with vocal cord lesions underwent microlaryngosurgery were included in this study（including polyps, vocal nodules, carcinoma, and papilloma, etc）, who were divided into DLE-group and non-DLE-group. Gender, age, height, weight, BMI and neck circumference were collected as general parameters, and hyoid-mental distance（HMD）, thyroid-mental distance（TMD）, horizontal thyroid-mental distance（HTMD）, vertical thyroid-mental distance（VTMD）, and sternum-mental distance（SMD） were measured as special parameters. Results： Univariate analysis showed that parameters like BMI, neck circumference, mallampati index, HMD, TMD, and SMD were related to intraoperative difficult exposure of the glottal area, and the difference was statistically significant（P0.05）. Multivariate statistical analysis proved that neck circumference40 cm, HMD6.05 cm, and SMD13.9 cm especially significant related with DLE. Conclusion： Anatomical characteristics of patients can affect the exposure of glottal area under laryngoscopy, so we should evaluate patients before operations for DLE according to related parameters.