改良马兰帕蒂试验和甲颏距离作为泰国患者困难喉镜检查的预测指标

Modified Mallampati test and thyromental distance as a predictor of difficult laryngoscopy in Thai patients.

作者信息

Ittichaikulthol Wichai, Chanpradub Suwanna, Amnoundetchakorn Sakda, Arayajarernwong Niramon, Wongkum Wilailux

机构信息

Department of Anesthesiology, Ramathibodi Hospital, Bangkok, Thailand.

出版信息

J Med Assoc Thai. 2010 Jan;93(1):84-9.

PMID:20196416

Abstract

BACKGROUND

Preoperative evaluation of anatomical landmarks and clinical factors are important in the detection of patients at risk for difficult laryngoscopy. The modified Mallampati test (MMT) and thyromental distance (TMD) are commonly used for this purpose but there are controversies regarding their accuracy.

OBJECTIVE

The objective of the present study was to evaluate the accuracy of MMT and TMD in the prediction of difficult laryngoscopy in Thai patients.

MATERIAL AND METHOD

1888 consecutive patients undergoing general anesthesia requiring endotracheal intubation were evaluated preoperatively using the MMT and TMD. The cut-off points for the difficult airway predictors were: Mallampati 3, 4 and TMD less than 6 cm. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grades III and IV were considered difficult laryngoscopy. Sensitivity and specificity for each airway predictor in isolation and in combination were determined.

RESULTS

The present study found Mallampati grade I 1050 patients (55.6%), grade II 730 patients (38.7%), grade III 104 patients (5.5%), grade IV 4 pateints (0.2%) and TMD less than 6 cm 85 patients (4.5%), TMD more than 6 cm 1803 patients (95.5%). Difficult laryngoscopy occurred in 60 patients (3.2%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the two airway predictors were: MMT 41.7%, 95.5%, 23.1% and 98.0% and TMD 23.3%, 96.1%, 16.5% and 97.4% respectively. The combination of two predictors with a sensitivity, specificity PPV and NPV were 55.0%, 92.3%, 19.1% and 98.4%.

CONCLUSION

MMT TMD and their combination are good predictors of difficult laryngoscopy in a Thai population.

摘要

背景

术前评估解剖标志和临床因素对于检测喉镜检查困难风险患者很重要。改良马兰帕蒂试验（MMT）和甲颏距离（TMD）通常用于此目的，但关于它们的准确性存在争议。

目的

本研究的目的是评估MMT和TMD在预测泰国患者喉镜检查困难方面的准确性。

材料与方法

对1888例连续接受全身麻醉并需要气管插管的患者术前使用MMT和TMD进行评估。困难气道预测指标的截断点为：马兰帕蒂分级3级、4级以及TMD小于6 cm。在直接喉镜检查期间，使用科马克和莱汉内（CL）分类法对喉镜视野进行分级。CL分级III级和IV级被视为喉镜检查困难。确定了每个气道预测指标单独及联合使用时的敏感性和特异性。

结果

本研究发现马兰帕蒂I级患者1050例（55.6%），II级患者730例（38.7%），III级患者104例（5.5%），IV级患者4例（0.2%），TMD小于6 cm患者85例（4.5%），TMD大于6 cm患者1803例（95.5%）。60例患者（3.2%）出现喉镜检查困难。两种气道预测指标的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为：MMT为41.7%、95.5%、23.1%和98.0%，TMD为23.3%、96.1%、16.5%和97.4%。两种预测指标联合使用时的敏感性、特异性、PPV和NPV分别为55.0%、92.3%、19.1%和98.4%。