附带咽喉枕囊气管导管对全身麻醉患者环杓关节脱位的预防作用及其效果评价

doi:10.13481/j.1671-587X.20250318

Abstract

Abstract:

Objective To observe the clinical effect of tracheal tube with an attached laryngeal pillow cushion （LPC） in the patients under general anesthesia， and to provide new methods for the preventing arytenoid dislocation during tracheal intubation. Methods Forty-eight patients scheduled for elective oral tracheal intubation under general anesthesia and meeting the inclusion criteria were selected. Based on the head and neck positions， the patients were divided into supine without pillow （SWOP） group， supine with pillow （SWP） group， trendelenburg position （TP） group， and head side position （HSP） group， each group consisted of 12 patients. The patient in the following groups underwent two sequential treatments after tracheal intubation： intervention group （LPC-inflated） and control group （LPC uninflated， representing the current method of tracheal tube use）. One patient in TP group and two patients in HSP group rminated the experiment， so a total of 45 patients were successfully included in this study. Electronic fiber laryngoscopy was used to observe and record the positional relationship between the endotracheal tube LPC and the posterior commissure arytenoid joint area under different head and neck positions after two treatments. The evaluation indicators were whether the tracheal tube was lifted from the posterior commissure arytenoid joint area and the degree of compression of the tracheal tube on the arytenoid joint. The incidence of tracheal tube lift-off and the percentage of compression degree on cricoarytenoid joint of the patients in various groups were calculated. Results Within the same head and neck position group， compared with control group， the incidence of endotracheal tube lift-off of the patients in intervention group was significantly increased （P<0.05）， and the percentage of compression degree of endotracheal tube on the arytenoid joint was significantly decreased （P<0.05）. In control and intervention groups， there were no statistically significant differences in the incidence of endotracheal tube lift-off and the percentage of compression degree on arytenoid joint of the patients in various head and neck positions groups （P>0.05）. Conclusion Under the four head and neck positions， inflating the LPC of the tracheal tube can lift the tracheal tube from the posterior commissure arytenoid joint area， effectively relieving or reducing the compression and mechanical friction injuries to the arytenoid joint.

Key words: Endotracheal tube, Laryngeal pillow cushion, Arytenoid dislocation, Posterior commissure, Compression injury, Friction injury

CLC Number:

R612

Xiao ZHANG,Mingxin JI,Shirui SHAN,Jiahao ZHANG,Linyu SUI,Xufang SUN. Preventive effect of endotracheal tube with laryngopharynx pillow cuff on cricoarytenoid joint dislocation in patients under general anesthesia and its effectiveness evaluation[J].Journal of Jilin University(Medicine Edition), 2025, 51(3): 740-748.

Figures/Tables 8

Fig. 1

Fig. 2

Fig. 3

Tab.1

Tab.2

Fig. 4

Tab.3

Fig. 5

References 27

[1]	耿志宇，高为华，王东信. 全身麻醉气管插管患者术后声带运动不良的临床结局［J］. 北京大学学报（医学版）， 2021， 53（2）： 337-340.
[2]	KOMORN R M， SMITH C P， ERWIN J R. Acute laryngeal injury with short-term endotracheal anesthesia［J］. Laryngoscope， 1973， 83（5）： 683-690.
[3]	JANG E A， YOO K Y， LEE S， et al. Head-neck movement may predispose to the development of arytenoid dislocation in the intubated patient： a 5-year retrospective single-center study［J］. BMC Anesthesiol， 2021， 21（1）： 198.
[4]	FROSOLINI A， MARIONI G， MAIOLINO L， et al. Current management of arytenoid sub-luxation and dislocation［J］. Eur Arch Otorhinolaryngol， 2020， 277（11）： 2977-2986.
[5]	WU L， SHEN L， ZHANG Y L， et al. Association between the use of a stylet in endotracheal intubation and postoperative arytenoid dislocation： a case-control study［J］. BMC Anesthesiol， 2018， 18（1）： 59.
[6]	TSURU S， WAKIMOTO M， IRITAKENISHI T， et al. Cardiovascular operation： a significant risk factor of arytenoid cartilage dislocation/subluxation after anesthesia［J］. Ann Card Anaesth， 2017， 20（3）： 309-312.
[7]	YAN W Q， DONG W H， CHEN Z. Prolonged tracheal intubation in the ICU as a possible risk factor for arytenoid dislocation after liver transplant surgery： a retrospective case-control study［J］. Ann Transplant， 2023， 28： e940727.
[8]	TAN P H， HUNG K C， HSIEH S W， et al. Large-bore calibrating orogastric tube and arytenoid dislocation： a retrospective study［J］. Br J Anaesth， 2016， 116（2）： 296-298.
[9]	YAMANAKA H， HAYASHI Y， WATANABE Y， et al. Prolonged hoarseness and arytenoid cartilage dislocation after tracheal intubation［J］. Br J Anaesth， 2009， 103（3）： 452-455.
[10]	吴林格尔，申乐，黄宇光. 气管插管后环杓关节脱位的危险因素与诊疗进展［J］. 中华麻醉学杂志， 2019， 39（6）： 644-646.
[11]	RUBIN A D， HAWKSHAW M J， MOYER C A， et al. Arytenoid cartilage dislocation： a 20-year experience［J］. J Voice， 2005， 19（4）： 687-701.
[12]	中华医学会麻醉学分会. 术后环杓关节脱位防治专家共识［J］. 临床麻醉学杂志， 2020， 36（7）： 705-707.
[13]	SIM Y H， CHOI J H， KIM M K. Arytenoid cartilage dislocation after reversed total shoulder replacement surgery in the beach chair position： a case report［J］. Korean J Anesthesiol， 2016， 69（4）： 382-385.
[14]	王铁全，李逸飞，王志华. 全麻术后环杓关节脱位预后因素的初步分析［J］. 中国微创外科杂志， 2022， 22（6）： 477-480.
[15]	PAULSEN F P， RUDERT H H， TILLMANN B N. New insights into the pathomechanism of postintubation arytenoid subluxation［J］. Anesthesiology， 1999， 91（3）： 659-666.
[16]	CLOSE L G， MERKEL M， WATSON B， et al. Cricoarytenoid subluxation， computed tomography， and electromyography findings［J］. Head Neck Surg， 1987， 9（6）： 341-348.
[17]	DUDLEY J P， MANCUSO A A， FONKALSRUD E W. Arytenoid dislocation and computed tomography［J］. Arch Otolaryngol， 1984， 110（7）： 483-484.
[18]	SENOGLU N， OKSUZ H， UGUR N， et al. Arytenoid dislocation related to an uneventful endotracheal intubation： a case report［J］. Cases J， 2008， 1（1）： 251.
[19]	OH T K， YUN J Y， RYU C H， et al. Arytenoid dislocation after uneventful endotracheal intubation： a case report［J］. Korean J Anesthesiol， 2016， 69（1）： 93-96.
[20]	TALMI Y P， WOLF M， BAR-ZIV J， et al. Postintubation arytenoid subluxation［J］. Ann Otol Rhinol Laryngol， 1996， 105（5）： 384-390.
[21]	NORIHITO SUZUKI H S. Clinical study of the incidence of arytenoid cartilage dislocation for the patients after general anesthesia with tracheal intubation［J］. J Anesth Clin Res， 2013， 4（10）： 1-5.
[22]	PAULSEN F P， JUNGMANN K， TILLMANN B N. The cricoarytenoid joint capsule and its relevance to endotracheal intubation［J］. Anesth Analg， 2000， 90（1）： 180-185.
[23]	FRIEDMAN A D， KOBLER J B， LANDAU-ZEMER T， et al. High-force simulated intubation fails to dislocate cricoarytenoid joint in ex vivo human larynges［J］. Ann Otol Rhinol Laryngol， 2012， 121（11）： 746-753.
[24]	龙送开，黄改军，郭渊源，等. 闭合性气管离断伤麻醉处理1例［J］. 中南大学学报（医学版）， 2024， 49（9）： 1538-1542.
[25]	WEYMULLER E A J， BISHOP M J， FINK B R， et al. Quantification of intralaryngeal pressure exerted by endotracheal tubes［J］. Ann Otol Rhinol Laryngol， 1983， 92（5 Pt 1）： 444-447.
[26]	SHEN L， WANG W T， YU X R， et al. Evaluation of risk factors for arytenoid dislocation after endotracheal intubation： a retrospective case-control study［J］. Chin Med Sci J， 2014， 29（4）： 221-224.
[27]	RANDESTAD A， LINDHOLM C E， FABIAN P. Dimensions of the cricoid cartilage and the trachea［J］. Laryngoscope， 2000， 110（11）： 1957-1961.

Group	n	Age （x±s）	Gender (η/%)		BMI （kg·m^－2）	ASA （Ⅰ/Ⅱ）
Group	n	Age （x±s）	Male	Female	BMI （kg·m^－2）	ASA （Ⅰ/Ⅱ）
SWOP	12	46.75±9.57	5（41.7）	7（58.3）	24.19±2.40	3（25.0）/9（75.0）
SWP	12	48.25±8.06	8（66.7）	4（33.3）	23.92±4.49	2（16.7）/10（83.3）
TP	11	47.36±8.31	4（36.4）	7（63.6）	25.03±3.42	2（18.2）/9（81.8）
HSP	10	50.10±6.56	5（50.0）	5（50.0）	25.25±4.16	1（10.0）/9（90.0）
F/χ²		0.332	2.464		0.338	0.983
P		0.802	0.482		0.798	0.950

Group	n	LPC-inflated		LPC-uninflated		P
Group	n	Occurring	Not occurring	Occurring	Not occurring	P
SWOP	12	10(83.3)	2(16.7)	1(8.3)	11(91.7)	0.004
SWP	12	9(75.0)	3(25.0)	2(16.7)	10(83.3)	0.016
TP	11	9(81.8)	2(18.2)	1(9.1)	10(90.9)	0.008
HSP	10	7(70.0)	3(30.0)	1(10.0)	9(90.0)	0.031
P		0.895		1.000

Group	n	LPC-inflated [n（η/%）]			Effective rate(η/%)	LPC-uninflated [n（η/%）]			Effective rate(η/%)	Z	P
Group	n	Degree Ⅰ	Degree Ⅱ	Degree Ⅲ	Effective rate(η/%)	Degree Ⅰ	Degree Ⅱ	Degree Ⅲ	Effective rate(η/%)	Z	P
SWOP	12	7（58.4）	4（33.3）	1（8.3）	91.7	1（8.3）	2（16.7）	9（75.0）	25.0	2.697	0.007
SWP	12	6（50.0）	4（33.3）	2（16.7）	83.3	2（16.7）	1（8.3）	9（75.0）	25.0	2.373	0.018
TP	11	6（54.5）	4（36.4）	1（9.1）	90.9	1（9.1）	2（18.2）	8（72.7）	27.3	2.521	0.012
HSP	10	5（50.0）	4（40.0）	1（10.0）	90.0	1（10.0）	2（20.0）	7（70.0）	30.0	2.226	0.026
Z		0.318				0.064
P		0.957				0.996

Preventive effect of endotracheal tube with laryngopharynx pillow cuff on cricoarytenoid joint dislocation in patients under general anesthesia and its effectiveness evaluation

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 8

References 27

Related Articles 1

Metrics

Comments

Recommended 0