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| 不同气道评估指标预测小耳畸形患儿喉镜显露困难的有效性 |
| Different airway assessments for difficult laryngoscopy in children with microtia |
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| DOI：10.12089/jca.2020.04.007 |
| 中文关键词: 甲颏间距 喉镜显露困难 困难气道；Cormack-Lehane分级 患儿 |
| 英文关键词: Thyromental distance Difficult laryngoscopic view Difficult airway Cormack-Lehane classification Children |
| 基金项目:2015北京协和医学院小规模特色教学改革专项 |
| 作者 | 单位 | E-mail | | 徐瑾 | 100144,北京市,中国医学科学院 北京协和医学院整形外科医院麻醉科 | | | 邓晓明 | 100144,北京市,中国医学科学院 北京协和医学院整形外科医院麻醉科 | dengxiaoming2003@sina.com | | 陈柯宇 | 100144,北京市,中国医学科学院 北京协和医学院整形外科医院麻醉科 | | | 王烨 | 100144,北京市,中国医学科学院 北京协和医学院整形外科医院麻醉科 | | | 魏灵欣 | 100144,北京市,中国医学科学院 北京协和医学院整形外科医院麻醉科 | | | 杨冬 | 100144,北京市,中国医学科学院 北京协和医学院整形外科医院麻醉科 | |
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| 中文摘要: |
目的 比较不同气道评估指标预测小耳畸形患儿喉镜显露困难（DLV）的有效性。
方法 择期全麻下行自体肋软骨耳廓重建术小耳畸形患儿200例,男159例，女41例，年龄6～14岁,ASA Ⅰ或Ⅱ级,麻醉诱导前评估改良Mallampati分级(MMT)、张口度(IIG)、甲颏间距(TMD)、下颌前伸能力(FPM)和身高/甲颏间距比值(RHTMD)。全麻吸入诱导下置入直接喉镜显露声门,评估Cormack-Lehane(C-L)分级,Ⅲ级和IV级视为DLV。采用受试者工作特征(ROC)曲线评估各项指标预测喉镜显露困难的效能。
结果 200例患儿中存在DLV有46例(23％)。MMT、IIG、TMD、FPM、RHTMD预测DLV的AUC(95％CI)分别为0.71(0.64～0.77)、0.74(0.67～0.80)、0.87(0.81～0.91)、0.61(0.54～0.68)和0.85(0.79～0.89),TMD和RHTMD预测效能优于MMT、IIG和FPM。
结论 TMD是小耳畸形患儿最佳气道评估指标。 |
| 英文摘要: |
Objective To explore the predictive capability of different airway assessments for difficult laryngoscopic view (DLV) in children with microtia.
Methods A total of 200 consecutive children with microtia, 159 males and 41 females, aged 6-14 years, falling into ASA physical status Ⅰ or Ⅱ, scheduled to undergo general anesthesia and surgery of auricle reconstruction with autogenous costal cartilage framework were invited to participate. Difficult airway assessments were performed by modified Mallampati test (MMT), interincisor gap (IIG), thyromental distance (TMD), forward protrusion of the mandible (FPM) and ratio of height to TMD (RHTMD) before induction. DLV was considered as grade III or IV of the Cormack-Lehane classification. Laryngoscopic view was assessed after induction. ROC analysis was used to determine the value with the performace at predicting DLV. Sensitivity, specificity and the area under the curve (AUC) were calculated to provide predictive accuracy.
Results A total of 46 (23％) children of microtia were diagnosed as DLV. AUC (95％CI) of MMT, IIG, TMD, FPM, RHTMD were 0.71 (0.64-0.77), 0.74 (0.67-0.80), 0.87 (0.81-0.91), 0.61 (0.54-0.68), and 0.85 (0.79-0.89), respectively. Overall, the sensitivity and specificity for TMD and RHTMD were better than MMT, IIG and FPM.
Conclusion TMD could be the most accurate assessment for DLV. |
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