超声法测量颈前软组织厚度对肥胖患者困难喉镜显露的预测价值  

Value of ultrasound-measured quantification of anterior neck soft tissue in predicting difficult laryngoscopy in obese patients

作　　者：金梅[1] 孙可[1] 袁亮婧[1] 杨庆国[1] 

机构地区：[1]北京积水潭医院麻醉科,100035

出　　处：《中华麻醉学杂志》2015年第1期99-101,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价超声法测量颈前软组织厚度对肥胖患者困难喉镜显露的预测价值.方法 拟于气管插管全麻下择期手术患者96例,BMI≥28 kg/m^2,年龄22 ～ 60岁,性别不限,ASA分级Ⅰ或Ⅱ级.麻醉前分别行改良Mallampati分级评估（M法）和超声法测量颈前软组织厚度评估（U法）,颈前超声扫描选择声带水平.设定U法＞20 mm,M法Ⅲ或Ⅳ级为阳性预测标准.麻醉诱导后直接喉镜下以Cormack-Lehane分级Ⅲ或Ⅳ级或无法置入喉镜者定义为困难喉镜显露.计算两种评估方法预测困难喉镜显露的敏感性、特异性和准确率.结果 困难喉镜显露患者22例,颈前软组织厚度（23.0±3.0） mm,明显厚于非困难喉镜显露患者[（16.9±2.2） mm] （P＜0.05）.U法预测困难喉镜显露的敏感性、特异性和准确率分别为91％、92％和92％,M法预测困难喉镜显露的敏感性、特异性和准确率分别为77％、81％和80％,差异有统计学意义（P＜0.05）.U法预测不同性别和年龄患者困难喉镜显露情况各指标比较差异无统计学意义（P＞0.05）.结论 超声法测量颈前软组织厚度大于20mm可准确地预测肥胖患者困难喉镜显露.Objective To evaluate the value of ultrasound-measured quantification of anterior neck soft tissue in predicting the difficult laryngoscopy in the obese patients.Methods Ninety-six patients,with body mass index ≥ 28 kg/m^2,aged 22-60 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia with endotracheal intubation,were selected.Assessment methods of modified Mallampati grade （method M） and anterior neck soft tissue quantification measured by ultrasound （method U） were performed before anesthesia.The level of vocal cords was selected using ultrasound scanning for anterior neck.The positive result was greater than 20 mm in method U,and was grade Ⅲ or Ⅳ in method M.Direct laryngoscope was placed after induction of anesthesia.Difficult laryngoscopy was defined as Cormack-Lehane grade Ⅲ or Ⅳ,or in whom laryngoscope could not be placed.The sensitivity,specificity and accuracy of the two assessment methods for predicting the difficult laryngoscopy were calculated.Results Twenty-two patients were found to have difficult laryngoscopy,and the anterior neck soft tissue quantification was （23.0±3.0） mm,which was significantly thicker than that in the patients of non-difficult laryngoscopy （（1.9±2.2） mm）.The sensitivity,specificity and accuracy of method U were 91%,92% and 92%,respectively,and of method M were 77%,81% and 80%,respectively,and there was significant difference between the two methods.There was no significant difference in the parameters of difficult laryngoscopy which were predicted using method U between the patients of different ages or gender.Conclusion It can accurately predict the difficult laryngoscopy in the obese patients when the ultrasound-measured quantification of anterior neck soft tissue is greater than 20 mm.

关 键 词：皮肤壁厚度 超声检查 喉镜检查 肥胖症 预测 

分 类 号：R614[医药卫生—麻醉学]