文章摘要
超声在预测患儿困难气管插管中的应用
Application of ultrasound in predicting difficult laryngoscopy in children
  
DOI：10.12089/jca.2019.02.009
中文关键词: 超声  气道管理  困难插管
英文关键词: Ultrasonography  Airway management  Difficult laryngoscopy
基金项目:
作者单位E-mail
高铮铮 100045,国家儿童医学中心,首都医科大学附属北京儿童医院麻醉科  
张建敏 100045,国家儿童医学中心,首都医科大学附属北京儿童医院麻醉科 zjm428@sina.com 
滑蕾 100045,国家儿童医学中心,首都医科大学附属北京儿童医院麻醉科  
王小雪 100045,国家儿童医学中心,首都医科大学附属北京儿童医院麻醉科  
高佳 100045,国家儿童医学中心,首都医科大学附属北京儿童医院麻醉科  
方欣 100045,国家儿童医学中心,首都医科大学附属北京儿童医院麻醉科  
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中文摘要:
      
目的 比较超声测量出的皮肤声门间距（distance from skin to vocal folds, DSV）、颈部直径(d)以及两者的比值（R）预测患儿困难插管的效能。
方法 全身麻醉气管插管患儿72例，男43例，女29例，年龄≤3岁，ASA Ⅰ或Ⅱ级，根据插管时Cormack-Lehane分级分为两组：Ⅰ—Ⅱ级，容易插管组（n=48）;Ⅲ—Ⅳ级，困难插管组（n=24）。在诱导后面罩通气时，超声下测量DSV，测量计算d和R，通过受试者工作特征（receiver operating characteristic, ROC）曲线分析，比较三种指标预测困难插管的能力，并通过最大化约登指数计算临界值。
结果 容易插管组DSV明显长于困难插管组（P<0.05）。R用于预测困难插管的曲线下面积（area under curve, AUC）为0.807，临界值为0.090，其敏感度为70.83%，特异度为83.33%。
结论 在年龄≤3岁的患儿中，应用超声测量并计算DSV与颈部直径的比值是一个优良的预测困难插管的方法。
英文摘要:
      
Ojective To compare the effect of ultrasound measurements of the distance from skin to vocal folds (DSV), neck diameter (d) and the ratio among the two measurements (R) used to predict difficult laryngoscopy.
Methods Seventy-two toddelers scheduled to undergo general anesthesia, aged ≤ 3 years, falling into ASA physical status Ⅰ or Ⅱ, were included and categorized as having easy (n = 48, grades Ⅰ and Ⅱ) or difficult (n = 24, grades Ⅲ and Ⅳ) laryngoscopy based on the criteria of Cormack and Lehane. When children were ventilated by mask, we measured DSV by ultrasound; obtained d and R. Receiver operating characteristic (ROC) curve analysis was used to determine the DSV, d and R in predicting difficult laryngoscopy. The value of cutoff was obtained by maximizing the Youden’s index.
Results DSV was significantly shorter in difficult laryngoscopy group (P < 0.05). The areas under the ROC curve of R was 0.807, and the cutoff value was 0.090. the sensitivity was 70.83%, the specificity was 83.33%.
Conclusion The ratio of distance from skin to vocal folds to neck diameter is a good predictor of difficult laryngoscopy in children under 3 years old.
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