强直性脊柱炎合并困难气道患者围手术期气道管理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2025.05.018

摘要/Abstract

摘要：

目的收集强直性脊柱炎合并困难气道患者围手术期气道管理的有效证据，并提炼最佳证据。方法系统检索国内外指南库、Cochrane Library、PubMed、OVID、Embase、Web of Science、中国知网、万方等数据库，查找强直性脊柱炎合并困难气道患者围手术期气道管理的相关文献，文献类型包括临床决策、最佳实践、指南、专家共识、系统评价及随机对照研究等，检索时限为建库至2023年5月19日。由两名独立研究员评估文献质量并提取关键信息。结果共纳入13篇文献，包括3篇临床决策、1篇最佳实践、3篇指南、4篇专家共识、1篇系统评价及1篇随机对照研究。从术前评估与准备、麻醉策略制订、术中监测与管理与术后加速康复管理4个方面归纳了22条核心证据。结论该研究为临床医护人员提供了科学的循证依据，有助于优化强直性脊柱炎合并困难气道患者的围手术期气道管理策略，降低并发症风险，加速患者康复进程，提升整体护理质量和治疗效果。

关键词: 强直性脊柱炎, 困难气道, 围手术期, 气道管理, 循证护理学

Abstract:

Objective To collect and summarize the effective evidence of perioperative airway management in patients with ankylosing spondylitis complicated with difficult airway. Methods We comprehensively and systematically searched literatures related to perioperative airway management in patients with ankylosing spondylitis complicated with difficult airway from relevant domestic and foreign guide websites，Cochrane Library，PubMed，OVID，Embase，Web of Science，CNKI，Wanfang and other databases. The literature types included clinical decision，best practices，guidelines，expert consensus，systematic reviews，and randomized controlled trials. The retrieval period was from the establishment of the database to May 19，2023. Two researchers independently evaluated literature quality and extracted data. Results Thirteen articles were included，including 3 clinical decisions，1 best practice，3 guidelines，4 expert consensuses，1 systematic review and 1 randomized controlled trial. The 22 best evidences were summarized from four aspects：preoperative assessment，anesthesia strategy，intraoperative monitoring，and postoperative rehabilitation. Conclusion This study provides clinical healthcare professionals with scientific evidence-based guidance，which helps to optimize the perioperative airway management strategies for patients with ankylosing spondylitis complicated with difficult airway，reduce the risk of complications，accelerate the rehabilitation process of patients，and improve the overall quality of nursing and treatment outcomes.

Key words: Ankylosing Spondylitis, Difficult Airway, Perioperative, Airway Management, Evidence-Based Nursing

马姚静, 王鑫鑫, 余群飞, 骆春美, 吴小燕, 王晓博, 朱岩, 任英. 强直性脊柱炎合并困难气道患者围手术期气道管理的最佳证据总结[J]. 中华急危重症护理杂志, 2025, 6(5): 603-609.

MA Yaojing, WANG Xinxin, YU Qunfei, LUO Chunmei, WU Xiaoyan, WANG Xiaobo, ZHU Yan, REN Ying. Evidence summary for perioperative airway management in patients with ankylosing spondylitis complicated with difficult airway[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(5): 603-609.

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参考文献 30

[1]	谢雅, 杨克虎, 吕青, 等. 强直性脊柱炎/脊柱关节炎患者实践指南[J]. 中华内科杂志, 2020, 59(7):511-518.
	Xie Y, Yang KH, Lü Q, et al. Practice guideline for patients with ankylosing spondylitis/spondyloarthritis[J]. Chin J Intern Med, 2020, 59(7):511-518. doi: 10.3760/cma.j.cn112138-20200505-00448 pmid: 32594684
[2]	钟寅波. 困难气道的处理[D]. 杭州: 浙江大学, 2011.
	Zhong YB. Treatment of difficult airway[D]. Hangzhou: Zhejiang University, 2011.
[3]	马姚静, 王鑫鑫, 余群飞, 等. 重度特发性脊柱侧凸患者肺康复的最佳证据总结[J]. 中华护理杂志, 2023, 58(14):1758-1765. doi: 10.3761/j.issn.0254-1769.2023.14.013
	Ma YJ, Wang XX, Yu QF, et al. Evidence summary of pulmo-nary rehabilitation in patients with severe idiopathic scoliosis[J]. Chin J Nurs, 2023, 58(14):1758-1765.
[4]	Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American society of anesthesiologists practice guidelines for management of the difficult airway[J]. Anesthesiology,2022, 136(1):31-81.
[5]	于布为, 吴新民, 左明章, 等. 困难气道管理指南[J]. 临床麻醉学杂志, 2013, 29(1):93-98.
	Yu BW, Wu XM, Zuo MZ, et al. Guide to difficult airway management[J]. J Clin Anesthesiol, 2013, 29(1):93-98.
[6]	Law JA, Duggan LV, Asselin M, et al. Canadian Airway Focus Group updated consensus-based recommendations for manage-ment of the difficult airway:part 2. Planning and implemen-ting safe management of the patient with an anticipated difficult airway[J]. J Can D’anesthesie, 2021, 68(9):1405-1436.
[7]	Liu ZJ, Yu XR, Dong Y, et al. Anesthesia strategies and perio-perative optimization for patients with ankylosing spondylitis undergoing total hip replacement surgery[J]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 2016, 38(3):305-311.
[8]	Eipe N, Fossey S, Kingwell SP. Airway management in cervical spine ankylosing spondylitis:between a rock and a hard place[J]. Indian J Anaesth, 2013, 57(6):592-595.
[9]	李天姿, 张慧芳, 黄月华, 等. 肝移植受者围手术期营养支持的最佳证据总结[J]. 中华急危重症护理杂志, 2024, 5(6):562-569.
	Li TZ, Zhang HF, Huang YH, et al. Summary of the best evi-dence of perioperative nutritional support for liver transplant recipients[J]. Chin J Emerg Crit Care Nurs, 2024, 5(6):562-569.
[10]	杨红燕, 兰美娟, 魏慧, 等. 颈动脉支架植入术患者围手术期血压管理的最佳证据总结[J]. 中华急危重症护理杂志, 2024, 5 (1):80-85.
	Yang HY, Lan MJ, Wei H, et al. Summary of the best evi dence for perioperative blood pressure management in carotid artery stenting patients[J]. Chin J Emerg Crit Care Nurs, 2024, 5(1):80-85.
[11]	毛越, 梁江淑渊, 张玉萍, 等. 经导管主动脉瓣置换术患者Ⅰ期心脏康复的最佳证据总结[J]. 中华急危重症护理杂志, 2021, 2(3):232-237.
	Mao Y, Liang JSY, Zhang YP, et al. Evidence summary of stage Ⅰcardiac rehabilitation following transcatheter aortic valve replacement[J]. Chin J Emerg Crit Care Nurs, 2021, 2(3):232-237.
[12]	Brouwers M, Kho M, Browman G, et al. AGREE Ⅱ:advancing guideline developmen,reporting and evaluation in health care[EB/OL].(2017-12-15)[2022-05-20]. http://www.agreetrust.org.
[13]	The Joanna Briggs Institute(JBI). Checklist for text and opi-nion[EB/OL].(2017-07-15)[2021-10-30]. http://joannabriggs.org/research/critical-appraisal-tools.html.
[14]	The Joanna Briggs Institute(JBI). Checklist for systematic re-views[EB/OL].(2017-07-15)[2021-10-30]. http://joannabriggs.org/research/critical-appraisal-tools.html.
[15]	Higgins J, Green S. Cochrane Handbook for systematic reviews of interventions,version 5.1.0(updated March 2011).[EB/OL].( 2011)[2021-10-30]. https://training.cochrane.org/handbook.
[16]	马喜宁, 白艳娟, 孔思铭, 等. 强直性脊柱炎患者运动指导方案的最佳证据总结[J]. 中华护理杂志, 2023, 58(7):864-870. doi: 10.3761/j.issn.0254-1769.2023.07.014
	Ma XN, Bai YJ, Kong SM, et al. Summary of the best evi-dence on exercise guidance programs for patients with ankylosing spondylitis[J]. Chin J Nurs, 2023, 58(7):864-870.
[17]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence recommendation level system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[18]	多学科围手术期气道管理中国专家共识(2018版) 专家组. 多学科围手术期气道管理中国专家共识(2018版)[J]. 中国胸心血管外科临床杂志, 2018, 25(7):545-549.
	Expert Group for the Chinese Expert Consensus on Multidi-sciplinary Perioperative Airway Management. Multidisciplinary perioperative airway management:Chinese expert consensus(2018 edition)[J]. Chin J Clin Thorac Cardiovasc Surg, 2018, 25(7):545-549.
[19]	Erik GL. Devices for difficult airway management in adults for emergency medicine and critical care[EB/OL].(2023-03-28)[2023-05-19]. https://www.uptodate.com/contents/devices-for-di-fficult-airway-management-in-adults-for-emergency-medicine-and-critical-care.
[20]	Axford JS, Shmerling RH, Romain PL. Preoperative evaluation and perioperative management of patients with rheumatic di-seases[EB/OL].(2023-03-18)[2023-05-19]. https://www.uptoda-te.com/contents/preoperative-evaluation-and-perioperative-mana-gement-of-patients-with-rheumatic-diseases.
[21]	Wang Y, Zheng GQ, Zhang YG, et al. Proposal of a new treat-ment-oriented classification system for spinal deformity in ankylosing spondylitis[J]. Spine Deform, 2018, 6(4):366-372. doi: S2212-134X(17)30237-X pmid: 29886906
[22]	Chang WD, Tsou YA, Lee CL. Comparison between specific exercises and physical therapy for managing patients with ankylosing spondylitis:a meta-analysis of randomized control-led trials[J]. Int J Clinic Exper Med, 2016, 9(9):17028-17039.
[23]	Joaquim AF, de Oliveira SA, Appenzeller S, et al. Spine sur-gery and ankylosing spondylitis:optimizing perioperative ma-nagement[J]. Clin Spine Surg, 2023, 36(1):8-14.
[24]	Xu LL, Hu ZY, Shen JJ. A comparison of the GlideScope with the Macintosh laryngoscope for nasotracheal intubation in patients with ankylosing spondylitis[J]. J Neurosurg Anesthe-siol, 2014, 26(1):27-31.
[25]	William HR, Carlos A. Management of the difficult airway for general anesthesia in adults[EB/OL].(2023-05-02)[2023-05-19]. https://www.uptodate.com/contents/management-of-the-diffi-cult-airway-for-general-anesthesia-in-adults.
[26]	北京中西医结合学会风湿病专业委员会. 强直性脊柱炎长期管理专家共识(2021年)[J]. 中国中西医结合杂志, 2021, 41(12):1426-1434.
	Rheumatology Professional Committee of Beijing Integrated Traditional Chinese and Western Medicine Association. Ex-pert consensus on long-term management of ankylosing spon-dylitis(2021)[J]. Chin J Integr Tradit West Med, 2021, 41(12):1426-1434.
[27]	吴明珑, 周雁荣, 詹雪, 等. 颈椎手术患者气道梗阻预防及管理的最佳证据应用[J]. 中华护理杂志, 2023, 58(2):133-140. doi: 10.3761/j.issn.0254-1769.2023.02.001
	Wu ML, Zhou YR, Zhan X, et al. Evidence-based nursing practice of airway obstruction prevention and management in patients undergoing cervical spinal surgery[J]. Chin J Nurs, 2023, 58(2):133-140. doi: 10.3761/j.issn.0254-1769.2023.02.001
[28]	中华医学会麻醉学分会. 困难气道管理专家共识[J]. 临床麻醉学杂志, 2009, 25(3):200-203.
	Anesthesiology Branch of Chinese Medical Association. Expert consensus on diffi-cult airway management[J]. J Clin Anesthe-siol, 2009, 25(3):200-203.
[29]	Parotto M, Cooper RM, Behringer EC. Extubation of the chal-lenging or difficult airway[J]. Curr Anesthesiol Rep, 2020, 10(4):334-340.
[30]	Sharan D, Rajkumar JS. Physiotherapy for ankylosing spondyli-tis:systematic review and a proposed rehabilitation protocol[J]. Curr Rheumatol Rev, 2017, 13(2):121-125.