【罂粟摘要】肥胖与非肥胖患者行择期手术的气道相关事件：一项横断面观察研究
肥胖与非肥胖患者行择期手术的气道相关事件：一项横断面观察研究
翻译：吴学艳 编辑：佟睿 审校：曹莹
贵州医科大学高鸿教授课题组
在英国，肥胖是一种日益普遍的现象。此项研究首要目的是明确肥胖患者所占择期手术人群中的比例；第二个目的是确定肥胖患者与非肥胖患者气道设备的选择和气道相关事件的发生率；2018年3月，对伦敦的39家医院进行了为期两个24小时的横断面观察研究。试验纳入1874例患者。研究人群中肥胖发生率为32%，而英国普通人群肥胖发生率为26% (p < 0.0001)。轻微的气道相关事件被定义为：SpO2降至<90%；面罩通气失败，声门上气道装置有问题，误吸，气道损伤，插管困难及已被发现的气管导管误入食管。严重气道相关事件定义为:未被发现误入食道的气管插管，“不能插管、不能通气”的紧急情况;非计划气管切开、心跳骤停及因气道事件而意外转入ICU。共记录89例轻微气道事件和2例严重气道事件。肥胖患者更易发生轻微气道事件(RR 2.39, 95%CI 1.60-3.57)，以血氧饱和度降低(SpO2< 90%)为主；肥胖患者与非肥胖患者相比，使用声门上气道装置与气道事件增加相关(RR 3.46[1.88-6.40])。气管插管与声门上气道装置的使用随着肥胖人群的增加而增加，但与气道事件减少无关(RR 0.90[0.53-1.55])。研究数据表明，与普通人群相比，肥胖患者在择期手术中更常见；与非肥胖患者相比，轻度气道事件在肥胖患者更为常见。
Airway events in obese vs. non-obese elective surgical patients: a cross-sectional observational study
Summary
Obesity is an increasingly prevalent comorbidity within the UK population. The aim of this study was to determine the proportion of obese patients in an elective surgical population. The second aim was to determine the choice of airway equipment and incidence of airway events in obese vs. non-obese patients. We conducted a cross-sectional observational study over two 24-h periods in March 2018 across 39 hospitals in the greater London area. Data were collected regarding 1874 patients. The incidence of obesity was 32% in the study population compared with 26% in the general UK population (p < 0.0001). Minor airway events were defined as: desaturation to S O < 90%; failed mask ventilation; supraglottic airway device problem; aspiration; airway trauma and difficult intubation; or recognised oesophageal intubation. Major airway events were defined as: unrecognised oesophageal intubation; a 'cannot intubate cannot oxygenate' emergency; the need for unplanned front-of-neck airway; cardiac arrest; or unplanned intensive care unit admission due to an airway event. In total, 89 minor and two major airway events were recorded. Obese patients were more likely to experience a minor airway event (RR 2.39, 95%CI 1.60-3.57), the most common being desaturation (S O < 90%). The use of a supraglottic airway device in obese vs. non-obese patients was associated with increased airway events (RR 3.46 [1.88-6.40]). Tracheal intubation vs. supraglottic airway device use increased with obesity class but was not associated with a decrease in airway events (RR 0.90 [0.53-1.55]). Our data suggest that obesity is more common in the elective surgical vs. general population and minor airway events are more common in obese vs. non-obese elective patients.