阻塞性睡眠呼吸暂停低通气综合征患者困难气管插管预测模型的构建  

Construction of a prediction model for difficult tracheal intubation in patients with obstructive sleep apnea-hypopnea syndrome

作　　者：李俊青 蔡宁[2] 梁东锋[2] 吴迪 陈光洪 袁浩 Li Junqing;Cai Ning;Liang Dongfeng;Wu Di;Chen Guanghong;Yuan Hao(Department of Anesthesiology,Fuyang Hospital Affiliated to Anhui Medical University,Fuyang 236000,China;Department of Anesthesiology Fuyang People′s Hospital,Fuyang 236000,China)

机构地区：[1]安徽医科大学附属阜阳医院麻醉科,阜阳236000 [2]阜阳市人民医院麻醉科,阜阳236000

出　　处：《中华麻醉学杂志》2023年第6期692-696,共5页Chinese Journal of Anesthesiology

基　　金：阜阳市卫生健康委科研课题(FY2019-036);阜阳市自筹经费科技计划项目(FK202081020);蚌埠医学院科研项目计划(BYKY2019237ZD)。

摘　　要：目的构建阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者困难气管插管预测模型。方法选择本院2019年6月至2021年6月收治的并存OSAHS的全麻手术患者324例为建模组,选择2021年7月至2022年7月收治的并存OSAHS的全麻手术患者175例作为验证组。建模组根据是否发生困难气管插管将患者分为发生组和未发生组。采用logistic回归构建预测模型,使用R 4.2.1软件绘制风险列线图以及校准曲线;以受试者工作特征(ROC)曲线下面积评价模型预测准确性。结果BMI、气道矢状向和水平向最小横截面积、下颌距离是OSAHS患者困难气管插管的危险因素(P<0.05),构建预测模型:Logit P=33.726+1.411×BMI评分-0.014×气道矢状向最小横截面积-0.013×气道水平向最小横截面积-0.312×下颌距离。建模组ROC曲线下面积0.846,约登指数0.585,灵敏度0.831,特异度0.755,准确度0.889(Hosmer-Lemeshow检验χ^(2)=9.24,P=0.322);验证组ROC曲线下面积0.802,约登指数0.545,灵敏度0.636,特异度0.908,准确度0.893(Hosmer-Lemeshow检验χ^(2)=10.24,P=0.287)。结论基于BMI、气道矢状向和水平向最小横截面积、下颌距离构建的预测模型,对OSAHS患者困难气管插管风险的预测价值较高。Objective To construct a prediction model for difficult tracheal intubation in the patients with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods A total of 324 patients with OSAHS undergoing surgery with general anesthesia,admitted to our hospital from June 2019 to June 2021,were included in model group,and 175 patients with OSAHS undergoing surgery with general anesthesia,admitted from July 2021 to July 2022,were selected and served as validation group.The patients in model group were divided into occurrence group and non-occurrence group according to whether difficult tracheal intubation occurred.Logistic regression was used to construct the prediction model,and R4.2.1 software was used to draw the risk nomogram and calibration curve.The predictive accuracy of the model was evaluated by the area under the receiver operating characteristic curve.Results Body mass index(BMI),sagittal minimum cross-sectional area,horizontal minimum cross-sectional area and mandibular distance were risk factors for difficult tracheal intubation in OSAHS patients(P<0.05).A prediction model was developed using the above factors:Logit P=33.726+1.411×BMI score-0.014×sagittal airway minimum cross-sectional area-0.013×airway horizontal minimum cross-sectional area-0.312×mandibular distance.The area under the receiver operating characteristic curve was 0.846,Youden index 0.585,sensitivity 0.831,specificity 0.755,and the accuracy 0.889(Hosmer-Lemeshow testχ^(2)=9.24,P=0.322)in model group.The area under the external validation curve was 0.802,Youden index 0.545,sensitivity 0.636,specificity 0.908,and the accuracy 0.893(Hosmer-Lemeshow testχ^(2)=10.24,P=0.287)in validation group.Conclusions The prediction model based on BMI,sagittal minimum cross-sectional area of airway,horizontal minimum cross-sectional area of airway and mandibular distance has a high value in predicting the risk of difficult tracheal intubation in patients with OSAHS.

关 键 词：睡眠呼吸暂停 阻塞性 插管法 气管内 预测 Logistic模型 

分 类 号：R766[医药卫生—耳鼻咽喉科]