上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (09): 1263-1269.doi: 10.3969/j.issn.1674-8115.2020.09.016

• 论著·临床研究 • 上一篇    下一篇

基于气道三维CT重建筛选颌面部间隙感染患者困难气道的预测指标

宋 巧，严 佳，周 韧，张 磊#，姜 虹#   

  1. 上海交通大学医学院附属第九人民医院麻醉科，上海200011
  • 出版日期:2020-09-28 发布日期:2020-11-04
  • 通讯作者: 姜 虹，电子信箱：jianghongjiuyuan@163.com。张 磊，电子信箱：weiymzhl@126.com。#为共同通信作者。
  • 作者简介:宋 巧（1994—），女，住院医师，硕士生；电子信箱：songq1030@163.com。
  • 基金资助:
    上海市教育委员会高峰高原学科建设计划（20191818）；上海交通大学“医工交叉”基金（ZH2018ZDA14）；上海交通大学医学院附属第九人民医院临床研究助推计划（JYLJ040）。

Application of 3D-CT reconstruction technology to predicting difficult airway in patients with odontogenic infections

SONG Qiao, YAN Jia, ZHOU Ren, ZHANG Lei#, JIANG Hong#   

  1. Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Online:2020-09-28 Published:2020-11-04
  • Supported by:
    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (20191818); “Medical-Industrial Intersection”Fund of Shanghai Jiao Tong University (ZH2018ZDA14)；Clinical Research Program of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (JYLJ040).

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摘要： 目的·评估气道三维CT（3D-CT）重建在颌面部间隙感染患者困难气道预测中的应用价值。方法·回顾性分析2017年8月—2019年7月于上海交通大学医学院附属第九人民医院行全身麻醉下颌面部间隙感染切开引流术患者的病例资料，选取已预测困难气道并接受清醒气管插管的患者为病例组（n=27）；从住院病例系统中选取非困难气道并接受麻醉快诱导气管插管的非颌面部间隙感染手术患者为对照组（n=27）。收集2组患者的头颈颌面部CT影像资料。采用Dolphin 11.9软件进行气道三维重建，分别测量腭咽、舌咽、口咽和喉咽的体积、正中矢状面面积、最小横截面积以及咽后壁厚度等指标。比较并筛选2组的差异指标，通过Logistic回归分析差异指标与困难气道的相关性。结果·病例组腭咽及喉咽体积，腭咽、口咽及喉咽正中矢状面面积，腭咽及喉咽平均横截面积，口咽最小横截面积及其左右径显著小于对照组（P<0.05）；病例组第二颈椎（C2）和第三颈椎（C3）水平咽后壁厚度显著大于对照组（P<0.05）。Logistic回归分析结果显示，腭咽、口咽及喉咽正中矢状面面积，喉咽体积及平均横截面积，C2和C3水平咽后壁厚度与困难气道具有相关性（P<0.05）。结论·气道3D-CT重建可清晰地显示颌面部间隙感染患者的气道受压情况，咽气道正中矢状面面积、喉咽体积及平均横截面积、C2和C3水平咽后壁厚度或可成为颌面部间隙感染患者困难气道的预测指标。

关键词: 困难气道, 颌面部间隙感染, 三维CT重建

Abstract:

Objective · To evaluate the application of 3D-CT airway reconstruction images to predicting difficult airway in patients with odontogenic infections. Methods · A retrospective analysis was performed on patients with odontogenic infections who were treated by incision and drainage under general anesthesia at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from August 2017 to July 2019, and patients who were evaluated as difficult airway receiving awake tracheal intubation were selected as the case group (n=27). From the “Hospital Inpatient System”, patients who were evaluated as non-difficult airway receiving fast induction were selected as the control group (n=27). Maxillofacial CT scans of all the patients were collected. The Dolphin Imaging software version 11.9 Premium was used to perform 3D-CT reconstruction of the airway. The upper airway was divided into oropharynx and hypopharynx, and the oropharynx was divided into velopharynx and glossopharyngeal. The indicators such as airway volume, median sagittal area, minimal cross-sectional area, and thickness of pharyngeal soft tissue were collected. The indicators of the difference between the two groups were compared and selected. Logistic regression analysis was conducted to investigate the association of these factors with difficult airway. Results · The volume of velopharynx and hypopharynx, the median sagittal area of velopharynx, oropharynx and hypopharynx, the mean cross-sectional area of velopharynx and hypopharynx, the minimal cross-sectional area and its lateral dimension of oropharyngeal of patients in the case group were significantly smaller than those of the controls (P<0.05). Thickness of pharyngeal soft tissue in the most inferior-anterior point of the second and the third cervical vertebrae of patients in the case group was significantly higher than that of the controls (P<0.05). The Logistic regression analysis showed that the median sagittal area of velopharynx, oropharynx and hypopharynx, the volume and mean cross-sectional area of hypopharynx, and thickness of pharyngeal soft tissue in the most inferior-anterior point of the second and the third cervical vertebrae of patients were related to difficult airway in patients with odontogenic infections (P<0.05). Conclusion · Airway 3D-CT reconstruction can clearly show the airway anatomy of patients with odontogenic infections. The median sagittal area of pharynx, the volume and mean cross-sectional area of hypopharynx, and thickness of pharyngeal soft tissue in the most inferior-anterior point of the second and the third cervical vertebrae may will be used as predictors of difficult airway in patients with odontogenic infections.

Key words: difficult airway, odontogenic infections, 3D-CT reconstruction

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