摘要
目的评价超声测量气道参数预测困难喉镜暴露的准确性。方法择期全麻手术患者104例,年龄18~70岁,ASA分级Ⅰ或Ⅱ级。麻醉诱导前行气道评估,记录患者BMI、颈围、张口度、甲颏间距及改良Mallampti分级,并采用超声测量颞下颌移动度、舌下表面深度、舌颏间距和会厌深度。测量结束后,行麻醉诱导,面罩加压通气后使用直接喉镜暴露声门,记录患者CL分级,以CL分级≥2b级作为困难喉镜暴露的标准。根据患者喉镜暴露的困难程度将其分为非困难喉镜暴露组(NDL)和困难喉镜暴露组(DL组)。将组间差异有统计学意义的因素,采用ROC曲线下面积(AUC)及其95%置信区间(95%CI)评价各指标预测困难喉镜暴露的准确性,结合约登指数确定预测喉镜暴露困难临界值,计算灵敏度和特异度。结果与NDL组比较,DL组BMI、会厌深度和改良Mallampti≥Ⅲ级比例升高,张口度和甲颏间距降低(P<0.05)。改良Mallampti分级和会厌深度预测困难喉镜暴露的AUC(95%CI)分别为0.728(0.619~0.836)和0.833(0.743~0.924)。会厌深度临界值为2.125 cm时,其预测困难喉镜暴露的灵敏度和特异度分别为65.71%和89.86%。结论超声测量会厌深度可较准确地预测困难喉镜暴露。
Objective To evaluate the accuracy of ultrasound-measured airway indicators in predicting difficult laryngoscopy.Methods A total of 104 American Society of Anesthesiologists physical statusⅠorⅡpatients,aged 18-70 yr,undergoing elective operation under general anesthesia,were selected.The airway was evaluated before induction of anesthesia,body mass index(BMI),neck circumference,mouth opening,thyromental distance and modified Mallampati classification were recorded,and mandibular condylar mobility,distance from skin to under surface of tongue,hyomental distance and distance from skin to epiglottis were measured by ultrasound.Anesthesia induction was performed after the end of measurement,and direct laryngoscopy was performed after mask pressure ventilation.Cormack-Lehane(CL)grade was recorded,and difficult laryngoscopy was defined as CL grade≥2b.The patients were divided into non-difficult laryngoscopy group(group NDL)and difficult laryngoscopy group(group DL)according to the view obtainable during laryngoscopy.The factors of which P values less than 0.05 would enter the logistic regression analysis.The accuracy of each index in predicting difficult laryngoscopy was evaluated using the area under the receiver operating characteristic curve(AUC)and 95%confidence interval(CI).The critical value was determined according to Youden index,and the sensitivity and specificity were calculated.Results Compared with NDL group,BMI,depth of epiglottis and the incidence of modified Mallampti≥gradeⅢwere significantly increased,and the mouth opening and thyromental distance were decreased in goup DL(P<0.05).The AUC(95%CI)of modified Mallampti classification and the depth of epiglottis for difficult laryngoscopy prediction were 0.728(0.619-0.836)and 0.833(0.743-0.924),respectively.When the critical value of depth of epiglottis was 2.125 cm,the sensitivity and specificity of predicting difficult laryngoscopy were 65.71%and 89.86%,respectively.Conclusion Ultrasound-measured depth of epiglottis can accurately predict the difficult laryngoscopy.
作者
王霞
陈娅璇
马武华
Wang Xia;Chen Yaxuan;Ma Wuhua(The First School of Clinical Medicine of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Department of Anesthesiology,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2021年第4期466-468,共3页
Chinese Journal of Anesthesiology
基金
广州市科技计划项目 (201707010297)
国家自然科学基金面上项目 (82074357)。
关键词
超声检查
气管内
喉镜检查
预测
Ultrasonography
Intratracheal
Laryngoscopy
Forecasting
作者简介
通信作者:马武华,Email:tuesdaymorninggz@126.com。
