锥形束CT测量舌厚度预测声门暴露困难的有效性

Effectiveness of cone-beam CT by measuring tongue thickness in predicting difficult glottis exposure

中文关键词: 锥形束计算机断层扫描  舌厚度  气道评估  声门暴露困难

英文关键词: Cone-beam computed tomography  Tongue thickness  Airway evaluation  Difficult glottis exposure

中文摘要:

      
目的： 探讨锥形束CT（CBCT）测量舌厚度（TT）在预测颌面外科手术患者声门暴露困难的有效性。
方法： 选择择期在全麻下行颌面手术患者97例，男45例，女52例，年龄18～67岁，ASA Ⅰ或Ⅱ级。术前采用CBCT测量TT，并记录张口度（IID）、BMI、甲颏距离（TMD）、改良Mallampati分级（MMT）。根据全麻诱导时Cormack-Lehane（CL）分级将患者分为两组：喉镜易显露组（E组，CL分级Ⅰ或Ⅱ级，n=86）和喉镜难显露组（D组，CL分级Ⅲ或Ⅳ级，n=11）。分析IID、BMI、TMD、MMT、TT与喉镜暴露的关系，并采用受试者工作特征（ROC）曲线分析各项指标预测喉镜显露困难的有效性。
结果： 与E组比较，D组BMI、MMT Ⅲ、Ⅳ级占比明显升高（P＜0.05），TT明显延长（P＜0.05），TMD明显缩短（P＜0.05）。BMI、TMD、MMT、TT预测喉镜暴露困难的ROC曲线下面积（AUC）分别为0.690、0.714、0.726、0.797，敏感性分别为36.4%、63.6%、63.6%、81.8%，特异性分别为95.3%、69.8%、76.7%、68.6%。将BMI、MMT、TMD、TT作为模型预测喉镜暴露困难AUC为0.913，敏感性为90.9%，特异性为83.7%。
结论： CBCT测量TT是预测喉镜暴露困难的独立影响因素，同时纳入BMI、TMD、MMT和TT四个指标的综合模型具有更好的预测效果。

英文摘要:

      
Objective: To investigate the accuracy of cone-beam CT (CBCT) by measuring tongue thickness (TT) in predicting difficult glottis exposure in patients undergoing maxillofacial surgery.
Methods: Ninety-seven patients undergoing elective maxillofacial surgery under general anesthesia were selected, 45 males and 52 females, aged 18-67 years, ASA physical status Ⅰ or Ⅱ. The TT was measured by CBCT before operation. The inter-incisor distance (IID), BMI, thyromental distance (TMD), and modified Mallampati test (MMT) were also recorded. According to the Cormack-Lehane (CL) grade at the time of general anesthesia induction, the patients were divided into two groups: the easy laryngoscope exposure group (group E, CL grade Ⅰ or Ⅱ, n = 86) and the difficult laryngoscope exposure group (group D, CL grade Ⅲ or Ⅳ, n = 11). The relationship between IID, BMI, TMD, MMT, TT, and laryngoscopy exposure was analyzed, and the receiver operating characteristic (ROC) curve was used to analyze the relationship between each index and difficult laryngoscopy exposure.
Results: Compared with group E, the BMI, MMT, and TT of group D were significantly increased (P < 0.05), while the TMD was significantly decreased (P < 0.05). The area under the ROC curve (AUC) of BMI, TMD, MMT, and TT to predict difficult glottis exposure was 0.690, 0.714, 0.726, and 0.797, the sensitivity was 36.4%, 63.6%, 63.6%, and 81.8%, and the specificity was 95.3%, 69.8%, 76.7%, and 68.6%, respectively. Using BMI, MMT, TMD, and TT as a model to predict difficult glottis exposure, the AUC was 0.913, the sensitivity was 90.9% and the specificity was 83.7%.
Conclusion: TT measured by CBCT is an independent impact factor for predicting difficult laryngoscope exposure. The comprehensive model incorporating BMI, TMD, MMT, and TT has a better predictive effect.