Abstract: Objective　To explore the application effect of 3D printing technology in assisting intubation for patients with difficult airway. Methods　Sixty patients who required orthopedic surgery under general anesthesia and had difficult airway at Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital) from January 2020 to June 2023 were selected, and were divided into a 3D group (30 cases) and a control group (30 cases) according to the random number table method. In the 3D group, there were 27 males and 3 females, with an age of (36.28±10.42) years old and a body mass index of (22.90±1.27) kg/m², and the American Society of Anesthesiologists (ASA) classification was grade II in 18 cases and grade III in 12 cases. In the control group, there were 26 males and 4 females, with an age of (35.89±11.06) years old and a body mass index of (22.84±1.52) kg/m², and the ASA classification was grade II in 15 cases and grade III in 15 cases. The 3D group used 3D printing technology to create a model of difficult airway before surgery and simulated tracheal intubation on the model; the control group used a video laryngoscope or bronchoscope for tracheal intubation based on the assessment results of common surface difficult airway indicators. The intubation time and the number of successful first intubation cases were recorded, and the hemodynamic indexes, stress responses, and intubation-related complications during intubation were evaluated. Statistical analysis was conducted using t test, non-parametric test, and χ² test. Results　Both groups had successful extubation after surgery. The intubation time, the number of times of intubations, and the proportions of changing intubation tools and post-extubation pharyngeal discomfort in the 3D group were all lower than those in the control group, with statistically significant differences (all P<0.05). Compared with those before induction, both groups showed a decrease in the systolic blood pressure (SBP) and diastolic blood pressure (DBP) after induction, with statistically significant differences (all P<0.05); compared with those after induction, the SBP and DBP of both groups increased 5 minutes and 30 minutes after intubation, with statistically significant differences (all P<0.05). Compared with those before induction, the blood glucose and cortisol levels in both groups increased 5 minutes after intubation, with statistically significant differences (all P<0.05); the blood glucose and cortisol levels in the 3D group were lower than those in the control group 5 minutes after intubation, with statistically significant differences (both P<0.05). During the intubation process of both groups, no tooth damage occurred, but a small amount of blood was found on the laryngoscope blades of a few patients. The incidences of hypoxia during intubation, postoperative 24-hour sore throat, and transient hoarseness in the 3D group were lower than those in the control group [3.33% (1/30) vs. 20.00% (6/30), 13.33% (4/30) vs. 40.00% (12/30), 3.33% (1/30) vs. 20.00% (6/30)], with statistically significant differences (all P<0.05). Conclusion　The application of 3D printing technology in difficult airway can shorten the intubation time, improve the success rate, and reduce the intubation injury.

Key words: 3D printing technology, Difficult airway, Tracheal intubation, Airway assessment

摘要： 目的　探讨3D打印技术辅助困难气道患者插管的应用效果。方法　选择2020年1月至2023年6月期间河南省洛阳正骨医院（河南省骨科医院）需要经全麻进行骨科手术且符合困难气道的患者60例，按照随机数字表将患者分成3D组（30例）和对照组（30例）。3D组男27例、女3例，年龄（36.28±10.42）岁，体重指数（22.90±1.27）kg/m²，美国麻醉医师协会（ASA）分级Ⅱ级18例、Ⅲ级12例；对照组男26例、女4例，年龄（35.89±11.06）岁，体重指数（22.84±1.52）kg/m²，ASA分级Ⅱ级15例、Ⅲ级15例。3D组术前应用3D打印技术作出困难气道模型并在模型上模拟气管插管，对照组根据普通体表困难气道指标评估结果，应用可视喉镜或纤支镜进行气管插管。记录两组患者插管时间、首次插管成功例数，评估插管期间血流动力学指标、应激反应以及插管相关并发症等指标。采用t检验、非参数检验、χ²检验进行统计学分析。结果　两组术后均顺利拔管；3D组插管时间、插管次数及更改插管工具、拔管后咽部不适比例均小于对照组，差异均有统计学意义（均P<0.05）。与诱导前比较，诱导后两组收缩压（SBP）、舒张压（DBP）均降低，差异均有统计学意义（均P<0.05）；与诱导后比较，插管后5 min及插管后30 min两组SBP、DBP均升高，差异均有统计学意义（均P<0.05）。与诱导前比较，插管后5 min两组血糖、皮质醇水平均升高，差异均有统计学意义（均P<0.05）；插管后5 min，3D组血糖、皮质醇水平均低于对照组，差异均有统计学意义（均P<0.05）。两组插管过程中均无牙齿受损情况发生，均有少数患者喉镜片有血迹，3D组插管中缺氧、术后24 h咽痛和短暂声音嘶哑发生率低于对照组［3.33%（1/30）比20.00%（6/30）、13.33%（4/30）比40.00%（12/30）、3.33%（1/30）比20.00%（6/30）］，差异均有统计学意义（均P<0.05）。结论　3D打印技术在困难气道中应用，能缩短插管时间、提高成功率、减轻插管损伤。

关键词: 3D打印, 困难气道, 气管插管, 气道评估