清醒及麻醉状态下5种口内扁桃体肥大评估方法可靠性比较  

Comparison of reliability of 5 evaluation methods for intraoral tonsil hypertrophy in awake and anesthetized individuals

作　　者：姚侃[1] 谢轶伦 于雯雯[1] 魏思龙[1] 夏亮[1] 郑彤 卢晓峰[1] YAO Kan;XIE Yi-lun;YU Wen-wen;WEI Si-long;XIA Liang;ZHENG Tong;LU Xiao-feng(Department of Oral and Craniomaxillofacial Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Shanghai 200011;Department of Stomatology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔颅颌面科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海200011 [2]上海交通大学医学院附属仁济医院口腔科,上海200127

出　　处：《中国口腔颌面外科杂志》2022年第5期461-465,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：上海交通大学医工(理)交叉基金资助(YG2022QN057)。

摘　　要：目的:比较清醒及麻醉状态下常用的5种口内扁桃体评估方法 的差异,为临床检测扁桃体提供依据。方法:收集218例3~14岁患者清醒及麻醉下的扁桃体照片资料,由3名经验丰富的医师分别利用5种扁桃体评估方法(Brodsky分度、Friedman分度、传统3度法、改良3度法、改良5度法)进行评估,对比清醒及麻醉下扁桃体大小的一致性。利用R语言软件进行统计学分析。结果:清醒与麻醉时扁桃体分度均存在一定差异。传统3度法ICC为0.58(0.51~0.64),Cronbach α为0.74(0.68~0.78):Friedman分度ICC为0.57(0.51~0.63),Cronbach α为0.73(0.67~0.77);改良3度法ICC为0.57(0.47~0.65),Cronbach α为0.72(0.64~0.79);改良5度法ICC为0.42(0.31~0.52),Cronbach α为0.59(0.47~0.69);Brodsky分度ICC为0.30(0.17~0.41),Cronbach α为0.46(0.29~0.59)。各评价体系中,2种状态评价一致均占比最多,而差异大多集中在清醒时低估了扁桃体大小。结论:清醒与麻醉状态下扁桃体存在一定差异,清醒状态下倾向于低估扁桃体的大小。目前所用5种口内扁桃体评估方法在大多数情况下能够相对准确地提示扁桃体的真实大小,具有一定的临床应用价值。PURPOSE:To determine the reliability of the 5 clinical grading scales of tonsillar size in reporting the size of tonsils in awake and anesthetized individuals. METHODS:Awake and anesthetized tonsillar images of 218 patients aged 3 to 14 years with no severe craniofacial abnormalities were retrospectively collected. For each patient, five separate tonsil assessments were conducted by 3 experienced experts. Intraclass correlation coefficients( ICC) and Cronbach’s α were used to determine the reliability of tonsil size in awake and anesthetized state. Statistical analysis was performed with R language(version 3.6.3). RESULTS:The reliability was highest for traditional 3-grade scale(ICC, 0.58;Cronbach’s α,0.74), followed by Friedman grading scale(ICC, 0.57;Cronbach’s α, 0.73), modified 3-grade scale(ICC, 0.57;Cronbach’sα, 0.72), modified 5-grade scale(ICC, 0.42;Cronbach’s α, 0.59) and Brodsky grading scale(ICC, 0.30;Cronbach’s α,0.46). CONCLUSIONS:The tonsils tended to be underestimated when the individuals were awake, while the 5 tonsil as-sessments were able to figure out the real volume of tonsils respectively.

关 键 词：阻塞性睡眠呼吸障碍 儿童 扁桃体肥大 扁桃体分度 

分 类 号：R766.4[医药卫生—耳鼻咽喉科] R782.05[医药卫生—临床医学]