超声测量颏下软组织距离预测喉罩通气不良的价值  

Value of ultrasonographic measurement of submental soft tissue distance in predicting poor ventilation with laryngeal mask airway

作　　者：张华[1] 夏菊荣[1] 冯冉冉 王波[1] 何丽君[2] Zhang Hua;Xia Jurong;Feng Ranran;Wang Bo;He Lijun(Department of Anesthesiology and Pain Management,The Third People′s Hospital of Hangzhou,Hangzhou 310009,China;Department of Special Examination,The Third People′s Hospital of Hangzhou,Hangzhou 310009,China)

机构地区：[1]杭州市第三人民医院麻醉疼痛科,310009 [2]杭州市第三人民医院特检科,310009

出　　处：《中华麻醉学杂志》2021年第7期848-851,共4页Chinese Journal of Anesthesiology

基　　金：浙江省医药卫生科技项目(2020KY723);杭州市社会发展科研自主申报项目(20180533B61)。

摘　　要：目的明确超声测量颏下软组织距离预测喉罩通气不良的价值。方法择期行下肢血管手术和泌尿系碎石手术患者272例,拟于喉罩全麻下完成。年龄25~78岁,ASA分级Ⅰ或Ⅱ级,体重40~85 kg,机械通气时间30~120 min。使用超声测量颏下舌距(TT)、颏下舌骨距离(DSHB)、颏下会厌距离(DSEM)和颏下声门距离(DSAC)。依据说明书选择喉罩型号。记录以下情况的发生:首次喉罩置入失败;机械通气期间喉罩套囊周围漏气;气道峰压>20 cmH2O;超声诊断胃进气。出现1种及以上情况者为通气不良。根据是否出现通气不良,将患者分为通气正常组(N组)和通气不良组(P组)。绘制超声测量颏下软组织距离预测喉罩通气不良的受试者工作特征曲线,并计算曲线下面积(AUC)及其95%可信区间(CI)、灵敏度、特异度及临界值。将组间比较有统计学差异的指标行单因素logistic回归分析,筛选喉罩通气不良的危险因素。结果超声测量TT、DSHB、DSEM及DSAC预测喉罩通气不良的AUC(95%CI)分别为:0.866(0.813~0.919)、0.755(0.683~0.827)、0.835(0.772~0.899)及0.705(0.628~0.782)(P<0.05或0.01);logistic回归分析结果显示:TT≥6.140 cm、DSHB≥1.145 cm、DSEM≥2.175 cm和DSAC≥1.075 cm均为喉罩通气不良的危险因素。结论超声测量TT、DSHB、DSEM及DSAC可预测喉罩通气不良的发生。Objective To determine the value of ultrasonographic measurement of submental soft tissue distance in predicting poor ventilation with laryngeal mask airway(LMA).Methods A total of 272 American Society of Anesthesiologists physical statusⅠorⅡpatients,aged 25-78 yr,weighing 40-85 kg,with mechanical ventilation time 30-120 min,scheduled for elective lower limb vascular surgery or lithotripsy under general anesthesia with LMA,were selected.The parameters of submental soft tissue of tongue thickness(TT),distance from skin to the hyoid bone(DSHB),distance from skin to epiglottis midway(DSEM)and distance from skin to anterior commissure of the vocal cords(DSAC)were measured using ultrasonography before operation.The type of LMA was chosen according to the instruction book.The development of failure of LMA placement at the first attempt,air leakage around LMA cuff during mechanical ventilation,peak airway pressure>20 cmH2O and gastric insufflation detected by ultrasonography were recorded.The development of one or more adverse events mentioned above was considered to be poor ventilation.The patients were divided into normal ventilation group(N group)and poor ventilation group(P group)according to whether poor ventilation occurred.The receiver operating characteristic curve for ultrasonographic measurement of submental soft tissue distance in predicting poor ventilation with LMA was drawn,and the area under the curve(AUC)and 95%confidence interval(CI),sensitivity and specificity and cut-off value were calculated.The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify the risk factors for poor ventilation with LMA.Results The AUC for TT,DSHB,DSEM and DSAC measured using ultrasonography in predicting poor ventilation with LMA(95%CI)was 0.866(0.813-0.919),0.755(0.683-0.827),0.835(0.772-0.899)and 0.705(0.628-0.782)(P<0.05 or 0.01),respectively.The results of logistic regression analysis showed that TT≥6.140 cm,DSHB≥1.145 cm,DSEM≥2.175 cm and DSAC≥1.075 cm we

关 键 词：超声检查 颏 喉面罩 预测 

分 类 号：R614[医药卫生—麻醉学]