紅細胞分布寬度與成人氣道重建手術結果的關係

Association Between Red Blood Cell Distribution Width and Outcomes of Open Airway Reconstruction Surgery in Adults

• Xie DX, Rehman SC, Francis DO, et al. Association Between Red Blood Cell Distribution Width and Outcomes of Open Airway Reconstruction Surgery in Adults. JAMA otolaryngology-- head & neck surgery 2019.
• Corresponding Author: Christopher T.Wootten, MD, Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, 2200 Children"sWay, Nashville, TN 37232 (christopher.t.wootten@vumc.org).

IMPORTANCE 重要性

Airway reconstruction for adults with laryngotracheal stenosis (LTS) is directed toward improving airway caliber to mitigate the patient"s dyspnea and achieve prosthesis-free breathing (ie, without tracheostomy, intraluminal stent, or T-tube). Despite the importance of preoperative risk stratification to minimize postoperative complications, consensus on an objective predictive algorithm for open airway reconstruction is lacking.

成人喉氣管狹窄（LTS）的氣道重建旨在改善氣道口徑，減輕患者的呼吸困難，實現人工呼吸（即，無氣管造口術、管腔內支架或T形管）。儘管術前風險分層對減少術後併發症很重要，但對於開放氣道重建的客觀預測演算法還缺乏共識。

OBJECTIVE 目的

To determine whether the ability to achieve a prosthesis-free airway in adults after open airway reconstruction is associated with red blood cell distribution width (RDW) at the time of surgery.

確定在開放氣道重建後成人中實現無假體氣道的能力是否與手術時的紅細胞分布寬度（RDW）相關。

DESIGN. SETTING. AND PARTICIPANTS 設計，設置與參與者

Case series study investigating 92 consecutive patients 18 years and older with laryngotracheal stenosis who underwent open airway reconstruction at a US tertiary care hospital from January 1,2006, to January 1,2017.

該案例系列研究調查了自2006年1月1日至2017年1月1日在美國三級護理醫院接受開放氣道重建的92名18歲及18歲以上喉氣管狹窄患者。

MAIN OUTCOMES AND MEASURES 主要結果與方法

The main outcome was a prosthesis-free airway (absence of tracheostomy, intraluminal stent, or T-tubes) at last follow-up. Multivariate logistic regression modeling was used to identify independent factors associated with this outcome.

主要結果是在最後一次隨訪時無假體氣道（沒有氣管造口術，腔內支架或T管）。 多變數邏輯回歸建模用於識別與該結果相關的獨立因素。

RESULTS 結果

Of the 92 patients who met inclusion criteria, the median (interquartile range) age was 44 (33.0-60.3) years； 50 (53%) were female, and 82 (89%) were white. In all, 74 patients (80%) were prosthesis free at the last follow-up (mean, 833 days; 95% Cl, 10-4229 days). In multivariate analyses, airway decannulation was significantly correlated with reduced RDW (odds ratio [OR], 0.40; 95% Cl, 0.19-0.84) and the absence of posterior glottic stenosis (OR. 0.12; 95% Cl. 0.04-0.37).

在符合納入標準的92名患者中，中位（四分位數間距）年齡為44（33.0-60.3）歲; 50名（53％）為女性，82名（89％）為白人。總共有74名患者（80％）在最後一次隨訪時沒有假體（平均833天; 95％ Cl，10-4229天）。 在多變數分析中，氣道拔管與RDW降低顯著相關（優勢比[OR]，0.40; 95％ Cl，0.19-0.84）和沒有後聲門狹窄（OR.1.12; 95％ Cl. 0.04-0.37）。

CONCLUSIONS AND RELEVANCE 結論與意義

These data suggest that surgical success in open airway reconstruction is significantly associated with RDW and whether the patient had posterior glottic stenosis. The RDW is a routine laboratory parameter that may provide some insight to the preoperative probability of prosthesis removal, facilitate risk stratification, promote informed patient decision making, and optimize health care resource management.

這些數據表明，開放氣道重建的手術成功與RDW以及患者是否有後聲門狹窄顯著相關。RDW是一個常規的實驗室參數，可以為術前移除假體的可能性提供一些見解，促進風險分層，促進明智的患者決策，優化醫療資源管理。

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