超声定位颈部解剖结构预测患者困难喉镜显露的准确性  

Accuracy of ultrasonic localization of cervical anatomy in predicting difficult laryngoscopy

作　　者：王偲 韦美良[1] 马茜 陈序[1] Wang Cai;Wei Meiliang;Ma Xi;Chen Xu(Department of Anesthesiology,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Anesthesiology,Jintan Hospital,Jiangsu University,Changzhou 213200,China)

机构地区：[1]广西医科大学第一附属医院麻醉科,南宁530021 [2]江苏大学附属金坛医院,常州213200

出　　处：《中华麻醉学杂志》2020年第7期847-850,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价超声定位颈部解剖结构预测患者困难喉镜显露的准确性。方法拟于全身麻醉下经口气管插管行择期手术患者91例,BMI 18.2~25.7 kg/m2,年龄18~75岁,性别不限,头颈活动度>90°,ASA分级Ⅰ或Ⅱ级。麻醉诱导前采用超声定位声带相对应的颈椎横突位置(Tx),测量声带前联合到其相对应颈椎横突两前结节连线水平的距离(DVA)、颏舌骨肌长度和皮肤到声带前联合的距离(DSV)。使用喉镜显露声门,然后行气管插管术。根据Cormack-Lehane分级将患者分为2组:非困难喉镜显露组(N组)和困难喉镜显露组(L组)。采用受试者工作特征曲线下面积(AUC)评价Tx、DVA、颏舌骨肌长度和DSV预测困难喉镜显露的准确性。结果Tx、DVA、颏舌骨肌长度及DSV预测困难喉镜显露的AUC分别为0.748、0.851、0.839和0.845,灵敏度分别为70.83%、75.00%、79.17%和87.50%,特异度分别为89.55%、89.55%、86.57%和83.58%,截断值分别为T4、4.43 cm、3.81 cm和0.72 cm。Tx、DVA、颏舌骨肌长度及DSV预测困难喉镜显露的AUC比较差异无统计学意义(P>0.05)。结论超声定位Tx、DVA、颏舌骨肌长度和DSV均可准确预测患者困难喉镜显露。Objective To evaluate the accuracy of ultrasonic localization of cervical anatomy in predicting difficult laryngoscopy.Methods A total of 91 patients,with body mass index of 18.2-25.7 kg/m2,aged 18-75 yr,regardless of gender,with a head and neck mobility>90°,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective surgery requiring oral tracheal intubation under general anesthesia,were included in the study.The position of cervical transverse process corresponding to vocal cords(Tx),distance from combination of vocal cords to connecting wire of two anterior tubercles of transverse processes(DVA),length of genitoglossus muscle,and distance from skin to combination of vocal cords(DSV)were localized by ultrasound before anesthesia induction.Laryngoscopy was used to expose the glottis,and then endotracheal intubation was performed.Patients were divided into 2 groups according to Cormack-Lehane classification:non-difficult laryngoscopy group(group N)and difficult laryngoscopy group(group L).The areas under the receiver operating characteristic curve(AUC)were used to evaluate the accuracy of Tx,DVA,length of genitoglossus muscle and DSV in predicting difficult laryngoscopy.Results The AUC of Tx,DVA,length of genitoglossus muscle and DSV in predicting difficult laryngoscopy was 0.748,0.851,0.839 and 0.845,respectively,the sensitivity was 70.83%,75.00%,79.17%and 87.50%,respectively,and the specificity was 89.55%,89.55%,86.57%and 83.58%,respectively,and the cut-off values were T4,4.43 cm,3.81 cm and 0.72 cm,respectively.There was no statistically significant difference in the AUC of Tx,DVA,length of genitoglossus muscle and DSV in predicting difficult laryngoscopy(P>0.05).Conclusion Tx,DVA,length of genitoglossus muscle and DSV localized by ultrasound all can predict difficult laryngoscopy accurately.

关 键 词：超声检查 解剖学 局部 喉镜检查 

分 类 号：R614[医药卫生—麻醉学]