Wilson风险评分预测困难气管插管的准确性  

Accuracy of Wilson risk score in predicting difficult tracheal intubation

作　　者：王茗芳 杨芳芳 王斌 姚卫东 金孝岠 Wang Mingfang;Yang Fangfang;Wang Bin;Yao Weidong;Jin Xiaoju(Department of Anesthesiology,First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院第一附属医院麻醉科,芜湖市241001

出　　处：《中华麻醉学杂志》2018年第9期1114-1118,共5页Chinese Journal of Anesthesiology

基　　金：安徽省高校自然科学研究项目(KJ2015A149).

摘　　要：目的评价Wilson风险评分预测困难气管插管的准确性。方法择期全麻手术患者,性别不限,年龄≥18岁,ASA分级为Ⅰ-Ⅲ级,所有患者由专门研究人员对其进行术前气道评估,项目包括:Wilson风险评分(5个危险因素:体重、下颔活动度、头颈部活动度、下颌退缩程度、门齿前突程度)、Mallampati分级、甲颏距离、张口度等。气道评估完成后,进行麻醉诱导,面罩加压通气3min后行气管插管术。主要观察结局为困难气管插管。应用受试者工作特征曲线(ROC)的曲线下面积(AUC)分析相应参数诊断困难气管插管的效果,应用Youden指数确定参数的最佳预测临界值及相应的敏感度和特异度。结果本研究共纳入1544例患者,其中困难气管插管37例。以预测困难气管插管进行ROC分析得出,Mallampati分级的AUC为0.65,甲颏距离的AUC为0.81,Wilson风险评分的AUC为0.91。与Mallampati分级和甲颏距离比较,Wilson风险评分预测困难气管插管时的AUC增加(P<0.05);与张口度比较,Wilson风险评分预测困难气管插管时的AUC差异无统计学意义(P>0.05)。Youden指数确定Wilson风险评分的最佳预预测临界值为>1分。结论Wilson风险评分预测困难气管插管时的准确性优于Mallampati分级和甲颏距离。Objective To evaluate the efficacy of Wilson risk score in predicting difficult tracheal intubation.Methods American Society of Anesthesiologists physical status Ⅰ -Ⅲ patients of both sexes, aged ≥18yr,undergoing elective surgery with general anesthesia,were enrolled in the study.All the patients were evaluated by the special researchers for assessment of the preoperative airway.The assessment items included the Wilson risk score (5 risk factors:weight,jaw movement,head and neck movement, mandible receding,buck teeth),modified Mallampati classification,thyromental distance,inter-incisor distance,etc.After the airway assessment was completed,anesthesia induction was conducted,and tracheal intubation was performed after 3min of pressure ventilation under the mask.The primary outcome was difficult tracheal intubation.The receiver operating characteristic curve and area under the curve (AUC) were used to analyze the efficacy of the corresponding parameters in diagnosing difficult tracheal intubation. The optimal predictive cut-off value and corresponding sensitivity and specificity of the parameters were determined by using the Youden index.Results A total of 1544 patients were enrolled in this study,and difficult intubation was found in 37 cases.The analysis of receiver operating characteristic curve showed that the AUC of the modified Mallampati classification was 0.65,and the AUC of the thyromental distance was 0.81,and the AUC of the Wilson risk score was 0.91.Compared with the modified Mallampati classification and thyromental distance,the AUC of Wilson risk score was significandy increased when used for predicting difficult tracheal intubation (P <0.05).Compared with the inter-incisor distance,no significant change was found in the AUC of Wilson risk score in predicting difficult tracheal intubation (P>0.05).The optimal predictive cut-off value of the Wilson risk score was more than 1,which was determined by the Youden index.Conclusion Wilson risk score provides better efficacy than the modified Mallampat

关 键 词：插管法 气管内 Wilson风险评分 

分 类 号：R614[医药卫生—麻醉学]