Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
J Neurosurg Anesthesiol. 2010 Apr;22(2):138-43. doi: 10.1097/ANA.0b013e3181ce6a60.
Upper lip bite test (ULBT) is a simple test for predicting difficult intubation. However, it has not been evaluated in acromegalic patients. The primary aim of this study was to compare ULBT with modified Mallampati classification (MMPC) to predict difficult laryngoscopy in acromegalic patients. Over a 5-year period, 64 acromegalic and 63 nonacromegalic patients presenting for excision of pituitary tumor were enrolled. Preoperative airway assessment was done using MMPC and the ULBT. Under anesthesia, laryngoscopic view was assessed using Cormack-Lehane (CL) grading. MMPC III/IV and ULBT grade III were considered predictive of difficult laryngoscopy that was defined as Cormack-Lehane grades III or IV. Difficult intubation was defined as more than 2 direct laryngoscopy attempts involving change of blade or use of bougie/fiberoptic bronchoscope/intubating laryngeal mask airway. Sensitivity, specificity, positive and negative predictive values, and accuracy of both tests in predicting difficult laryngoscopy were calculated. Incidence of difficult laryngoscopy and intubation in acromegalics were 24% and 11%, respectively. MMPC and ULBT predicted difficulty in 61% and 14% acromegalics, respectively. However, only 26% and 44% of the laryngoscopies predicted to be difficult by MMMC and ULBT, respectively, were actually difficult. MMPC failed to predict 33% of difficult laryngoscopies whereas ULBT failed to predict 73%. Neither test predicted difficulty in 33% laryngoscopies that turned out to be difficult. Twenty-seven percent of the difficult laryngoscopies were correctly predicted by both tests. In acromegalic group, MMPC was more sensitive, whereas ULBT was more specific. Sensitivity and accuracy of both tests were less in acromegalic patients compared with nonacromegalic controls.
上唇咬合试验（ULBT）是一种预测困难插管的简单测试。然而，它尚未在肢端肥大症患者中进行评估。本研究的主要目的是比较 ULBT 与改良 Mallampati 分级（MMPC）在预测肢端肥大症患者困难喉镜检查中的作用。在 5 年期间，纳入了 64 例肢端肥大症和 63 例非肢端肥大症患者，这些患者均因垂体瘤切除术而就诊。使用 MMPC 和 ULBT 进行术前气道评估。在麻醉下，使用 Cormack-Lehane（CL）分级评估喉镜检查视野。MMPC III/IV 和 ULBT 分级 III 被认为可预测困难喉镜检查，即 Cormack-Lehane 分级 III 或 IV。困难插管定义为超过 2 次直接喉镜尝试，包括更换刀片或使用气管插管探条/纤维支气管镜/插管喉罩气道。计算两种测试预测困难喉镜检查的敏感性、特异性、阳性和阴性预测值以及准确性。肢端肥大症患者中困难喉镜检查和插管的发生率分别为 24%和 11%。MMPC 和 ULBT 分别预测 61%和 14%的肢端肥大症患者存在困难。然而，只有 26%和 44%的 MMPC 和 ULBT 预测为困难的喉镜检查实际上是困难的。MMPC 未能预测 33%的困难喉镜检查，而 ULBT 未能预测 73%。两种测试均未能预测 33%的实际困难喉镜检查。27%的困难喉镜检查被两种测试正确预测。在肢端肥大症组中，MMPC 更敏感，而 ULBT 更特异。与非肢端肥大症对照组相比，两种测试在肢端肥大症患者中的敏感性和准确性均较低。
