不同方法预测困难气道喉镜插管有效性的比较

Comparison of predictive capability of different methods for difficult laryngoscopy

中文关键词: 甲颏高度  困难气道  Cormack Lehane分级  甲颏距离

英文关键词: Thyromental height  Difficult airway  Cormack-Lehane grade  Thyromental distance

中文摘要:

      目的 比较不同方法预测困难气道喉镜插管的有效性,并分析其最佳临界点。方法选择行全麻气管插管择期手术患者300例,年龄18～65岁,体重42～88 kg,ASA Ⅰ或Ⅱ级,麻醉诱导前评估甲颏高度（TMH）、甲颏距离(TMD)、胸颏间距(SMD)、改良 Mallampti 分级(MMT)和身高甲颏距离比(RHTMD)。在全麻诱导下直接喉镜暴露声门评估 Cormack-Lehane(CL)分级，Ⅲ级和Ⅳ级视为喉镜插管困难。计算上述几种方法的受试者工作特征（ROC）曲线下面积（AUC），预测困难喉镜插管的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和精确度。绘制 TMH的受试者工作特征曲线(ROC曲线)并确定其最佳临界点。结果300例患者中喉镜插管困难的患者有22例（73%）。TMH法的敏感性、特异性、PPV、NPV、精确度明显高于TMD、SMD、MMT法;RHTMD法的敏感性低于TMH法,特异性、PPV、NPV、精确度与TMH法相似。根据ROC曲线TMH法的最佳临界点为49 cm。结论TMH预测国人困难喉镜插管的最佳临界点为49 cm。其评估困难气道效能与RHTMD相似,高于TMD、SMD和 MMT。

英文摘要:

      Objective To explore the predictive capability of different methods for difficult laryngoscopy and analyze its optimal cutoff value. Methods Three hundred consecutive patients (aged 18-65 years, weighing 42-88 kg, ASA physical status Ⅰ or Ⅱ) scheduled to undergo general anesthesia and surgery were invited to participate. Difficult airway assessments were performed by thyromental height (TMH), thyromental distance (TMD), sternomental distance (SMD), modified Mallampati test (MMT) and ratio of height and TMD (RHTMD) before anesthetic induction. Cormack-Lehane (C L) grade of laryngoscopy view was assessed after induction. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of these tests were calculated. Receiver operator characteristic (ROC) curve of TMH was performed to determine the optimal cutoff value of TMH. ResultsThere were 22 patients diagnosed as difficult airway. Sensitivity, specificity, PPV, NPV and accuracy of TMH were higher than those of TMD, SMD and MMT tests. Sensitivity of RHTMD was lower than that of TMH test, and specificity, PPV, NPV and accuracy of RHTMD were similar to that of TMH. The optimal cutoff value of TMH was 49 cm through ROC curve. Conclusion The optimal cutoff value of TMH detecting difficult laryngoscopy was 49 cm. Similar to RHTMD, TMH appears to be more effective for prediction of difficult laryngoscopy than TMD, SMD and MMT.