發(fā)布時間：2018-05-10 16:59

  本文選題：環(huán)杓關(guān)節(jié)脫位 + 體質(zhì)指數(shù)��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:評估全麻氣管內(nèi)插管引起的環(huán)杓關(guān)節(jié)脫位的危險(xiǎn)因素。方法:回顧性分析浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院自2014年9月至2016年9月期間,在我院全麻氣管內(nèi)插管術(shù)后出現(xiàn)環(huán)杓環(huán)節(jié)脫位28例患者的臨床資料。對照組選擇了與28例手術(shù)方式與麻醉方式相同的患者56例(以1:2配對)。分析的危險(xiǎn)因素包含:個人基本情況(性別、年齡、身高、體重)、吸煙狀態(tài)、飲酒狀態(tài)、手術(shù)持續(xù)時間及麻醉相關(guān)因素(氣管導(dǎo)管管徑、氣管導(dǎo)管類型、插管次數(shù)、操作者經(jīng)驗(yàn)以及插管輔助工具)。環(huán)杓關(guān)節(jié)脫位患者診斷依據(jù)病史、喉鏡檢查、咽喉部高分辨率CT檢查,以及基于CT圖像的環(huán)杓關(guān)節(jié)三維重建。統(tǒng)計(jì)方法中,二分類變量用頻率與百分?jǐn)?shù)表示,卡方檢驗(yàn)對兩組數(shù)據(jù)進(jìn)行統(tǒng)計(jì)比較;連續(xù)性變量用平均數(shù)±標(biāo)準(zhǔn)差表示,采用獨(dú)立樣本的T檢驗(yàn)進(jìn)行數(shù)據(jù)統(tǒng)計(jì);使用logistic回歸模型進(jìn)行多因素分析,篩查獨(dú)立的危險(xiǎn)因素,以P0.05表明統(tǒng)計(jì)顯著性。結(jié)果:28例氣管內(nèi)插管引起的環(huán)杓關(guān)節(jié)脫位患者中,男18例,女10例,平均年齡55歲。左側(cè)環(huán)杓關(guān)節(jié)脫位16例(57.14%,16/28),右側(cè)環(huán)杓關(guān)節(jié)脫位12例(42.86%,12/28),左、右側(cè)脫位無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。單因素分析結(jié)果提示年齡(P=0.567)、性別(P=0.568)、手術(shù)時間(P=0.179)、吸煙狀態(tài)(P=0.399)以及飲酒狀態(tài)(P=0.104)與氣管內(nèi)插管引起的環(huán)杓關(guān)節(jié)脫位的發(fā)生率無明顯相關(guān)性。氣管導(dǎo)管管徑(p=0.473)、氣管導(dǎo)管類型(P=1.000)、插管次數(shù)(P=0.110)、操作者經(jīng)驗(yàn)(P=0.202)及插管輔助工具(P=0.536)上二組之間無明顯統(tǒng)計(jì)學(xué)差異。BMI(體質(zhì)指數(shù))與環(huán)杓關(guān)節(jié)脫位相關(guān)(P0.01)。logistic回歸分析表明低BMI是氣管內(nèi)插管引起的環(huán)杓關(guān)節(jié)脫位的獨(dú)立危險(xiǎn)因素(P=0.048)。男性BMI低于21.5 kg/m2組較大于和/或等于21.5 kg/m2組環(huán)杓關(guān)節(jié)脫位的發(fā)生有統(tǒng)計(jì)學(xué)差異(P=0.041);女性BMI低于20.5 kg/m2組較大于和/或等于20.5 kg/m2組環(huán)杓關(guān)節(jié)脫位的發(fā)生有統(tǒng)計(jì)學(xué)差異(P=0.043)。結(jié)論:1、低BMI是氣管內(nèi)插管引起的環(huán)杓關(guān)節(jié)脫位的獨(dú)立危險(xiǎn)因素,BMI低于21.5 kg/m2的男性和BMI低于20.5 kg/m2的女性行全麻氣管內(nèi)插管較易發(fā)生環(huán)杓關(guān)節(jié)脫位。2、基于CT掃描圖像的環(huán)杓關(guān)節(jié)三維重建,可有效鑒別環(huán)杓關(guān)節(jié)脫位與聲帶麻痹。3、表麻下行閉合復(fù)位術(shù)是一種有效且安全的治療手段。
[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 鹵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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
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本文編號：1870123