中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2026, Vol. 24 ›› Issue (2): 144-149.doi: 10.19438/j.cjoms.2026.02.008

• 论著 • 上一篇    下一篇

肥胖患者口腔颌面外科手术气管插管次数的危险因素分析

尼加提·米尔卡米力1, 周韧2, 孙宇2   

  1. 1.新疆维吾尔自治区人民医院 麻醉手术中心,新疆 乌鲁木齐 830001;
    2.上海交通大学医学院附属第九人民医院 麻醉科,上海 200011
  • 收稿日期:2025-10-22 修回日期:2025-12-08 出版日期:2026-03-20 发布日期:2026-04-02
  • 通讯作者: 孙宇,E-mail: dr_sunyu@163.com
  • 作者简介:尼加提·米尔卡米力（1988—）,男,硕士,主治医师,E-mail: njt0919@163.com

Multiple intubation attempts in obese patients during oral and maxillofacial surgery: analysis of risk factors

Nijiati Mierkamili1, Zhou Ren2, Sun Yu2   

  1. 1. Department of Anesthesiology and Operating Theater, People's Hospital of Xinjiang Uygur Autonomous Region. Urumqi 830001, Xinjiang Uygur Autonomous Region;
    2. Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China
  • Received:2025-10-22 Revised:2025-12-08 Online:2026-03-20 Published:2026-04-02

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摘要： 目的: 探讨肥胖患者口腔颌面外科手术导致气管插管次数增加的危险因素。方法: 回顾性纳入2021年2月—2024年7月于上海交通大学医学院附属第九人民医院接受全麻下口腔颌面外科手术的肥胖患者（BMI≥28 kg/m2）1 425例。收集患者病史、气道解剖参数及麻醉诱导相关资料,根据气管插管次数,将患者分为单次成功组（1 394例）和多次插管组（31例）。采用单因素及多因素logistic回归分析筛选导致气管插管次数增加的独立危险因素。结果: 多因素分析显示,颈部活动度受限（OR=4.71,95%CI：1.03~15.44,P=0.021）和上颌前突（OR=11.999,95%CI：1.682~55.128,P=0.003）是多次插管的独立危险因素;而舒芬太尼的使用为其保护因素（OR=0.394,95%CI：0.187~0.789,P=0.011）。结论: 对拟行口腔颌面外科手术的肥胖患者,术前应重视评估颈部活动度及上颌前突情况,必要时预先准备困难气道处理方案或采用清醒插管。合理选用麻醉药物及诱导策略,可能有助于减少多次气管插管。

关键词: 肥胖, 口腔颌面外科, 气管插管, 危险因素, 困难气道

Abstract: PURPOSE: To investigate the risk factors for increased tracheal intubation attempts in obese patients undergoing oral and maxillofacial surgery. METHODS: A total of 1 425 obese patients (BMI ≥ 28 kg/m2) who underwent general anesthesia for oral and maxillofacial surgery in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from February 2021 to July 2024 were enrolled retrospectively. The patients' medical history, airway anatomical parameters and data related to anesthetic induction were collected. According to the number of tracheal intubation attempts, the patients were divided into the single-attempt success group(n=1 394) and the multiple-attempt intubation group (n=31). Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for increased number of tracheal intubation attempts. RESULTS: Multivariate analysis revealed that limited neck mobility (OR=4.71, 95%CI: 1.03-15.44, P=0.021) and maxillary protrusion(OR=11.999, 95%CI: 1.682-55.128, P=0.003) were independent risk factors for multiple intubation attempts. The use of sufentanil was identified as a protective factor(OR=0.394, 95%CI: 0.187-0.789, P=0.011). CONCLUSIONS: Preoperative assessment of obese patients scheduled for maxillofacial surgery should emphasize evaluating neck mobility and maxillary protrusion. When necessary, difficult airway management protocols or awake intubation should be considered. Appropriate selection of anesthetic agents and induction strategies may help reduce the incidence of multiple intubation attempts.

Key words: Obesity, Oral and maxillofacial surgery, Tracheal intubation, Risk factors, Difficult airway

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