超声判断喉罩置入位置的准确性:3D-CTR评价  

Accuracy of ultrasonography in determining laryngeal mask airway position: evaluation using 3D-CTR

作　　者：吕爽 苌恩强 范育彩 阮孝国 张加强 Lyu Shuang;Chang Enqiang;Fan Yucai;Ruan Xiaoguo;Zhang Jiaqiang(Department of Anesthesiology and Perioperative Medicine,Zhengzhou University People′s Hospital Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院河南省人民医院麻醉与围术期医学科,450003

出　　处：《中华麻醉学杂志》2021年第1期76-79,共4页Chinese Journal of Anesthesiology

摘　　要：目的以三维CT重建(3D-CTR)图像为标准,评价超声判断喉罩置入位置的准确性。方法选择本院行脑血管介入性支架手术患者134例,年龄18~64岁,体重30~100 kg,ASA分级Ⅰ或Ⅱ级。分别于喉罩置入前后进行颈部超声检查,术中进行数字减影血管造影检测获得3D-CTR图像。分析患者颈部超声和3D-CTR图像并进行分级。结果最终125例患者完成本研究。在喉罩垂直位置上,超声分级与3D-CTR分级呈正相关(r=0.742,P<0.05);超声判断喉罩旋转的灵敏度为73.0%(95%CI:62.0%~84.4%)、特异度92.8%(95%CI:86.9%~98.7%)、阳性预测值89.1%(95%CI:80.5%~97.7%)、阴性预测值81.0%(95%CI:72.6%~89.4%)、准确度74.2%(95%CI:65.2%~81.1%)。在喉罩深度分级方面,超声分级与3D-CTR分级呈正相关(r=0.332,P<0.05),超声判断喉罩深度的灵敏度为58.5%(95%CI:46.9%~70.1%)、特异度93.3%(95%CI:87.2%~99.4%)、阳性预测值90.5%(95%CI 82.0%~99.0%)、阴性预测值67.5%(95%CI:57.7%~77.3%)、准确度33.2%(95%CI:16.8%~47.8%)。超声判断喉罩最佳置入位置的阳性预测值61.1%(95%CI:48.6%~73.6%)。结论虽然超声无法测量喉罩尖端入食管的深度,但检测旋转的准确性较高,可以作为临床上检测喉罩位置,尤其是旋转的可靠工具。Objective To evaluate the accuracy of ultrasonography in determining the laryngeal mask airway position using three-dimensional CT reconstruction(3D-CTR)images as the standard.Methods One hundred and thirty-four patients,aged 18-64 yr,weighing 30-100 kg,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective cerebral vascular interventional stent surgery in our hospital,were selected.Cervical ultrasonography was performed before and after laryngeal mask airway placement,and digital subtraction angiography was performed during operation to obtain 3D-CTR images.Neck ultrasound and 3D-CTR images were analyzed and graded.Results A total of 125 patients completed the study.At the vertical position of the laryngeal mask airway,ultrasonic grading was positively correlated to 3D-CTR grading(r=0.742,P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasound in determining the rotation of the laryngeal mask airway was 73.0%(95%CI:62.0%-84.4%),92.8%(95%CI:86.9%-98.7%),89.1%(95%CI:80.5%-97.7%),81.0%(95%CI:72.6%-89.4%),and 74.2%(95%CI 65.2%-81.1%),respectively.In terms of laryngeal mask airway depth grading,the correlation between ultrasonic grading was positively correlated to 3D-CT grading(r=0.332,P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of ultrasound in determining the depth of the laryngeal mask airway was 58.5%(95%CI:46.9%-70.1%),93.3%(95%CI:87.2%-99.4%),and 90.5%(95%CI:82.0%-99.0%),67.5%(95%CI:57.7%-77.3%),and 33.2%(95%CI:16.8%-47.8%),respectively.The positive predictive value of ultrasound in determining the optimal placement of the laryngeal mask airway was 61.1%(95%CI:48.6%-73.6%).Conclusion Although ultrasound cannot measure the depth of the tip of the laryngeal mask airway into the esophagus,it has higher accuracy in determining the rotation and can be used as a reliable tool for clinical detection of the position of the laryngeal mask airway,especially the rotation.

关 键 词：超声检查 体层摄影术 X线计算机 成像 三维 喉面罩 

分 类 号：R614[医药卫生—麻醉学]