超声测量联合LEMON法在阻塞性睡眠呼吸暂停低通气综合征患者困难气道评估中的应用研究  

Application of ultrasonography combined with LEMON method in the evaluation of difficult airway in patients with OSAHS

作　　者：陈以建[1] 周文[1] 李以平[1] CHEN Yi-jian;ZHOU Wen;LI Yi-ping(Department of Anesthesiology,Ganzhou People's Hospital,Ganzhou,Jiangxi 341000)

机构地区：[1]赣州市人民医院麻醉科,江西赣州341000

出　　处：《赣南医学院学报》2023年第12期1250-1254,共5页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：赣州市科技局指导性科技计划项目(GZ2020ZSF160)。

摘　　要：目的:分析使用超声测量联合LEMON法评估阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea hypopnea syndrome,OSAHS)患者困难气道的准确性。方法:选择择期全麻气管插管下行改良腭咽成形术OSAHS患者46例,根据插管时Cormack-Lehane分级分为两组:Ⅰ、Ⅱ级为非喉镜暴露困难组27例,Ⅲ、Ⅳ级为喉镜暴露困难组19例。麻醉前测量张口度、甲颏距离,评估改良Mallampati分级,患者麻醉后在相同体位下行气管插管。比较常规评估气道方法和超声测量联合LEMON法与喉镜显露困难的关系,采用受试者工作特征曲线(Receiver operating characteristic curve,ROC)分析各指标预测困难气道的效能。结果:喉镜暴露困难组超声测量数据、LEMON法评分、改良Mallampati分级高于非喉镜暴露困难组(P<0.05)。超声测量联合LEMON法的曲线下面积(Area under curve,AUC)为0.990(95%CI 0.969~1.000),高于单独应用超声测量或LEMON法的AUC值。结论:超声测量和LEMON法均可有效对OSAHS患者困难气道进行评估,其中超声测量预测OSAHS患者困难气道具有较好的效果,超声测量联合使用LEMON法可提高评估OSAHS患者困难气道的准确性。Objective:To analyze the accuracy of combined ultrasonic measurement and LEMON method in assessing difficult airway in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:A total of 46 OSAHS patients undergoing improved palatopharyngoplasty under elective general anesthesia were selected.The mouth opening and nail and chin distance were measured before anesthesia,and the modified Mallampati grade was evaluated.After anesthesia,the patients underwent tracheal intubation in the same position.Two groups were divided according to the Cormack-Lehane classification at the time of intubation:27 cases in the non-laryngoscopic exposure difficulty group in grades Ⅰ and Ⅱ,and 19 cases in the laryngoscopic exposure difficulty group in grades Ⅲ and Ⅳ.The relationship between conventional airway assessment method,ultrasonic measurement combined LEMON method and laryngoscope exposure difficulty was compared,and receiver operating characteristic curve(ROC)was used to analyze the efficiency of each index in predicting difficult airway.Results:The ultrasonic measurement data,LEMON score and modified Mallampati grade in the laryngoscopic exposure difficulty group were higher than those in the non-laryngoscopic exposure difficulty group(P<0.05).The area under curve(AUC)of ultrasonic measurement combined with LEMON method was 0.99(95%CI 0.969~1),which was higher than that of ultrasonic measurement alone or LEMON method.Conclusion:Both ultrasonic measurement and LEMON method can effectively evaluate the difficult airway of patients with OSAHS,among which ultrasonic measurement has a better effect on predicting the difficult airway of patients with OSAHS,and the combination of ultrasonic measurement and LEMON method can improve the accuracy of assessing the difficult airway of patients with OSAHS.

关 键 词：超声测量 LEMON法 睡眠呼吸暂停 阻塞性 气道评估 困难气道 

分 类 号：R614.2[医药卫生—麻醉学]