超声测量颈前软组织厚度预测喉镜暴露困难的价值

Value of ultrasound measurement of anterior neck soft tissue thickness in predicting difficult laryngoscopy

中文关键词: 喉镜暴露困难  超声  预测效能  颈前软组织厚度  受试者工作特征曲线

英文关键词: Difficult laryngoscopy  Ultrasound  Predictive value  Anterior cervical soft tissue thickness  Receiver operating characteristic curve

中文摘要:

      
目的 应用超声测量不同水平的颈前软组织厚度，评价超声技术预测喉镜暴露困难的价值。

方法 选择行择期全身麻醉气管插管患者86例，男48例，女38例，年龄18～80岁，BMI 18～35 kg/m²，ASA Ⅰ—Ⅲ级。麻醉诱导后记录相应的Cormack-Lehane（C-L）分级， Ⅲ—Ⅳ级为喉镜暴露困难。术后进行传统和超声气道检查，测量改良马氏分级（MMT）、张口度（MO）、颈围（NC）、甲颏距离（TMD）、胸颏距离（SMD）、舌骨至皮肤的距离（DSH）、会厌至皮肤距离（DSE）、声带前联合至皮肤距离（DSV）、甲状腺峡部气管环至皮肤距离（DST）等，绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC）和95%可信区间（CI），筛选相关变量纳入综合模型，评估喉镜暴露困难的预测价值。

结果 通过ROC曲线评价各项指标预测喉镜暴露困难的诊断价值，DSE的AUC为0.889（95%CI 0.803～0.947）、DST的AUC为0.718（95%CI 0.610～0.810）、SMD的AUC为0.700（95%CI 0.591～0.736），其中DSE的预测效能最佳，截断值为2.10 cm，其余指标BMI、MMT、MO、NC、TMD、DSH、DSV的AUC小于0.7。纳入MO、SMD、DSE、DST四个指标的综合模型， AUC为0.92（95%CI 0.866～0.975）。

结论 超声测量DSE可用于预测喉镜暴露困难，截断值为2.10 cm，比其他指标具有更好的预测能力，纳入MO、SMD、DSE、DST的综合预测模型可以进一步提高预测能力。

英文摘要:

      
Objective To assess the value of ultrasound technique in difficult laryngoscopy and to measure different levels of anterior cervical soft tissue thickness.

Methods Eighty-six patients, 48 males and 38 females, aged 18-80 years, BMI 18-35 kg/m², ASA physical stutas Ⅰ-Ⅲ, undergoing general anesthesia requiring tracheal intubation were enrolled. After induction of anesthesia, the Cormack-Lehane (C-L) grades was recorded by laryngoscopy, and grades Ⅲ—Ⅳ were difficult laryngoscopy. After the operation, traditional and ultrasound airway examinations were performed to measure the patient's modified Mallampati test (MMT), mouth opening (MO), neck circumference (NC), thyromental distance (TMD), sternomental distance (SMD), the distance from skin to hyoid bone (DSH), the distance from skin to epiglottis (DSE), the distance from the front of the vocal cords to the skin (DSV), and the distance from skin to thyroid isthmus (DST). The indicators were analyzed and a receiver operating characteristic (ROC) curves were plotted, area under curve (AUC) and 95% confidence interval (CI) were calculated, and relevant variables were screened for inclusion in an integrated model to assess the predictive effect of difficult laryngoscopy.

Results ROC curves were used to evaluate the diagnostic value of diffierent indicators for predicting difficult laryngoscopy. Among the indicators, the AUC of DSE was 0.889 (95% CI 0.803-0.947), AUC of DST was 0.718 (95% CI 0.610-0.810), AUC of SMD was 0.700 (95% CI 0.591-0.736). These showed high diagnostic values and DSE had the best predictive efficacy with a cut-off value of 2.10 cm. The AUCs of BMI, MMT, MO, NC, TMD, DSH, and DSV were less than 0.7 and the diagnostic value for difficult laryngoscopy was moderate. The AUC of the combined model incorporating the four indices of MO, SMD, DSE, and DST was 0.92 (95% CI 0.866-0.975).

Conclusion The DSE can be used to distinguish difficult and easy laryngoscopies; the DSE cutoff value of 2.10 cm resulted in a more powerful predictive value than other indicators for predicting a difficult laryngoscopy. The comprehensive prediction model incorporating MO, SMD, DSE, and DST can further improve the predictive power.