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| 肩-腋-胸骨上切迹指数在急诊创伤患者喉镜暴露困难中的预测价值 |
| Predictive value of shoulder-axillary-sternal notch index in difficult laryngoscopic exposure in emergency trauma patients |
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| DOI：10.12089/jca.2025.04.008 |
| 中文关键词: 肩-腋-胸骨上切迹指数 喉镜暴露困难 气管插管 急诊 预测 |
| 英文关键词: Acromio-axillo-suprasternal notch index Difficult to expose laryngoscope Tracheal intubation Emergency Prediction |
| 基金项目:安徽省卫生健康科研项目（AHWJ2023BAc20120） |
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| 中文摘要: |
目的：探讨肩-腋-胸骨上切迹指数（AASI）在急诊创伤患者喉镜暴露困难中的预测价值。
方法：选择急诊收治行全麻气管插管的创伤手术患者198例，男143例，女55例，年龄18～75岁，BMI 18.5～28.0 kg/m 2，ASA Ⅰ—Ⅲ级。按照Cormack-Lehane（C-L）喉镜暴露分级法分为两组：喉镜暴露困难组（D组，n=32）和非喉镜暴露困难组（N组，n=166）。气管插管前对所有患者进行AASI、甲颏间距、Mallampati分级评估。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC），评估不同气道评估指标预测喉镜暴露困难的效能。
结果：与N组比较，D组AASI明显升高，甲颏间距明显缩短，Mallampati分级Ⅲ/Ⅳ级比例明显升高（P<0.05）。ROC曲线结果显示，Mallampati分级预测喉镜暴露困难的AUC为0.705（95%CI 0.598～0.811），AASI预测的AUC为0.873（95%CI 0.807～0.939），AASI联合Mallampati分级预测的AUC为0.908（95%CI 0.863～0.953）。
结论：AASI在预测急诊创伤患者喉镜暴露困难中的价值良好，具有较高的敏感性和特异性，当测量值≥0.52时提示喉镜暴露困难可能，相较于单一指标，AASI联合Mallampati分级能够进一步提高预测效能。 |
| 英文摘要: |
Objective: To investigate the predictive value of shoulder-axillary-sternal notch index (AASI) in difficult laryngoscopic exposure in emergency trauma patients.
Methods: A total of 198 patients, 143 males and 55 females, aged 18-75 years, BMI 18.5-28.0 kg/m 2, ASA physical status Ⅰ-Ⅲ, undergoing emergency trauma surgery were selected. According to the Cormack-Lehane (C-L) laryngoscope exposure grading method, the patients were divided into difficult laryngoscope exposure group (group D, n = 32) and non-difficult laryngoscope exposure group (group N, n = 166). Before tracheal intubation, AASI, thyromental distance and Mallampati grading were evaluated in all patients. The receiver operating characteristic (ROC) curve was drawn to analyze the area under the curve (AUC) to evaluate the efficacy of different airway evaluation indicators in predicting difficult laryngoscopy exposure.
Results: Compared with group N, the AASI was significantly increased, the thyromental distance was significantly shortened, and the proportion of Mallampati grade Ⅲ or Ⅳ was significantly increased in group D (P < 0.05). The results of ROC curve showed that the AUC of Mallampati grading prediction was 0.705 (95% CI 0.598-0.811), and the AUC of AASI prediction was 0.873 (95% CI 0.807-0.939). The AUC predicted by AASI combined with Mallampati classification was 0.908 (95% CI 0.863-0.953).
Conclusion: AASI has a good value in predicting the difficulty of laryngoscopic exposure in emergency trauma patients, with high sensitivity and specificity. When the measured value is greater than or equal to 0.52, it indicates that laryngoscopic exposure may be difficult. Compared with single index, AASI combined with Mallampati classification can further improve the predictive ability. |
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