气道超声参数预测肥胖患者困难面罩通气的准确性  

Accuracy of airway ultrasonic parameters in predicting difficult mask ventilation in obese patients

作　　者：黄洁[1] 李攀 张佳齐 张玮玮[3] 祁月红[3] 王妮荣 高建辉 余淑珍[3] Huang Jie;Li Pan;Zhang Jiaqi;Zhang Weiwei;Qi Yuehong;Wang Nirong;Gao Jianhui;Yu Shuzhen(Department of Anesthesiology,Maternal and Child Hospital of Hunan Province,Changsha 410000,China;School of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,People′s Hospital of Shanxi Province,Taiyuan 030012,China)

机构地区：[1]湖南省妇幼保健院麻醉手术科,长沙410000 [2]山西医科大学麻醉学院,太原030001 [3]山西省人民医院麻醉科,太原030012

出　　处：《中华麻醉学杂志》2023年第12期1486-1489,共4页Chinese Journal of Anesthesiology

基　　金：湖南省卫生健康委科研计划项目资助(202304117544)。

摘　　要：目的评价气道超声参数预测肥胖患者困难面罩通气(DMV)的准确性。方法选择气管插管全麻下择期手术患者96例,年龄>18岁,性别不限,BMI 28~<40 kg/m^(2),ASA分级Ⅰ或Ⅱ级。术前1 d进行临床气道评估,记录甲颏距离、改良Mallampati分级、咬上唇试验分级。麻醉诱导前采用超声测量髁状突活动度、舌纵截面积及舌横径,计算舌体积。麻醉诱导后面罩通气,记录面罩通气困难分级,以面罩通气困难分级Ⅲ和Ⅳ级为DMV标准,将患者分为非DMV组(NDMV组)和DMV组。采用Spearman相关分析各指标与DMV的相关性,采用受试者工作特征曲线(ROC)曲线评价各指标预测DMV的准确性,根据约登指数最大原则确定截断值。结果最终纳入96例患者,其中NDMV组64例,DMV组32例。与NDMV组比较,DMV组年龄增大,改良Mallampati分级、咬上唇试验分级、舌纵截面积、舌横径、舌体积升高,甲颏距离、髁状突活动度降低(P<0.05)。年龄(r=0.283)、改良Mallampati分级(r=0.668)、咬上唇试验(r=0.826)、舌纵截面积(r=0.598)、舌横径(r=0.578)、舌体积(r=0.707)与DMV呈正相关(P<0.01),甲颏距离(r=-0.623)、髁状突活动度(r=-0.666)与DMV呈负相关(P<0.05)。舌纵截面积、舌横径、舌体积、髁状突活动度预测DMV的AUC(95%CI)分别为0.870(0.780~0.961)、0.858(0.768~0.948)、0.937(0.864~1.000)、0.912(0.835~0.990)(P<0.01),其预测截断值分别为22.61 cm^(2)、4.29 cm、100.60 cm^(3)、1.18 cm,灵敏度和特异度分别为90%和80%、83%和80%、90%和95%、90%和95%。结论超声测量的舌体积、髁状突活动度预测肥胖患者DMV的准确性高,舌体积>100.60 cm^(3)或髁状突活动度<1.18 cm提示患者发生DMV的风险较高。Objective To evaluate the accuracy of airway ultrasonic parameters in predicting difficult mask ventilation(DMV)in obese patients.Methods Ninety-six patients of both sexes,aged>18 yr,with body mass index of 28-<40 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,scheduled for elective surgery under general anesthesia with endotracheal intubation,were selected.The airway was evaluated at 1 day before surgery to record the thyromental distance,modified Mallampati classification and upper lip bite test classification.Before anesthesia induction,the mandibular condylar motion,longitudinal cross-sectional area and transverse diameter of the tongue were measured by ultrasound,and the tongue volume was calculated.Mask ventilation was performed after anesthesia induction,DMV classification was recorded,DMV was defined as DMV classificationⅢandⅣ,and the patients were divided into non-DMV group(NDMV group)and DMV group.Spearman correlation analysis was used to analyze the correlation between each parameter and DMV,the receiver operating characteristic(ROC)curve was used to evaluate the accuracy of each parameter in predicting DMV,and the cut-off value was determined based on the principle of Jorden index at maximum.Results Ninety-six patients were finally included in the study,with 64 patients in NDMV group and 32 patients in DMV group.Compared with NDMV group,the increase in age,modified Mallampati grade,upper lip biting test grade,longitudinal cross-sectional area of tongue,transverse diameter of tongue and volume of tongue were significantly increased,and the thyromental distance and mandibular condylar motion were decreased in DMV group(P<0.05).Age(r=0.283),modified Mallampati grade(r=0.668),upper lip biting test classification(r=0.826),tongue longitudinal cross-sectional area(r=0.598),tongue transverse diameter(r=0.578)and tongue volume(r=0.707)were positively correlated with DMV(P<0.01),and thyromental distance(r=-0.623)and mandibular condylar motion(r=-0.666)were negativel

关 键 词：超声检查 呼吸 人工 面罩 预测 

分 类 号：R614[医药卫生—麻醉学]