与四种预测剖宫产产妇困难喉镜检查的测试相比，颈围与颏甲距离之比的预测价值。
The predictive value of the ratio of neck circumference to thyromental distance in comparison with four predictive tests for difficult laryngoscopy in obstetric patients scheduled for caesarean delivery.
作者信息
Hirmanpour Anahita, Safavi Mohammadreza, Honarmand Azim, Jabalameli Mitra, Banisadr Golnaz
机构信息
Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
Adv Biomed Res. 2014 Sep 30;3:200. doi: 10.4103/2277-9175.142045. eCollection 2014.
BACKGROUND
Preoperative assessment of anatomical landmarks andclinical factors help detect potentially difficult laryngoscopies. The aim of the present study was to compare the ability to predict difficult visualization of the larynx from thefollowing preoperative airway predictive indices, in isolation and combination: Neck circumference to thyromental distance (NC/TMD), neck circumference (NC), modified Mallampatitest (MMT), the ratio of height to thyromental distance (RHTMD), and the upper-lip-bite test (ULBT).
MATERIALS AND METHODS
We collected data on657 consecutive patients scheduled for elective caesarean delivery under general anesthesia requiring endotracheal intubation and then evaluated all five factors before caesarean. An experienced anesthesiologist, not informed of the recorded preoperative airway evaluation, performed the laryngoscopy and grading (as per Cormack and Lehane's classification). Sensitivity, specificity, and positive and negative predictive values for each airway predictor in isolation and in combination were determined.
RESULTS
Difficult laryngoscopy (Grade 3 or 4) occurred in 53 (8.06%) patients. There were significant differences in thyromental distance (TMD), RHTMD, NC, and NC/TMD between difficult visualization of larynx and easy visualization of larynx patients (P < 0.05). The main end-point area under curve (AUC) of the receiver-operating characteristic (ROC) was lower for MMT (AUC = 0.497; 95% Confidence Interval = CI,0.045-0.536) and ULBT (AUC = 0.500, 95% CI, 0.461-0.539) compared to RHTMD, NC, TMD, and NC/TMD score ([AUC = 0.627, 95% CI, 0.589-0.664], [AUC = 0.691; 95% CI, 0.654-0.726], [AUC = 0.606; 95% CI, 0.567-0.643], [AUC = 0.689;95% CI, 0.625-0.724], respectively), and the differences of six ROC curves were statistically significant (P < 0.05).
CONCLUSION
The NC/TM Discomparable with NC, RHTMD, and ULBT for the prediction of difficult laryngoscopy in caes are an delivery.
背景
术前对解剖标志和临床因素进行评估有助于发现潜在的困难喉镜检查情况。本研究的目的是比较以下术前气道预测指标单独及联合使用时预测喉镜视野困难的能力：颈围与颏甲距离（NC/TMD）、颈围（NC）、改良马兰帕蒂试验（MMT）、身高与颏甲距离之比（RHTMD）以及上唇咬合试验（ULBT）。
材料与方法
我们收集了连续657例计划在全身麻醉下行择期剖宫产且需要气管插管的患者的数据，然后在剖宫产术前对所有五项因素进行评估。一名经验丰富的麻醉医生在不知道术前气道评估记录的情况下进行喉镜检查并分级（按照科马克和莱汉内分类法）。确定了每个气道预测指标单独及联合使用时的敏感性、特异性、阳性预测值和阴性预测值。
结果
53例（8.06%）患者出现困难喉镜检查（3级或4级）。喉镜视野困难的患者与喉镜视野容易的患者在颏甲距离（TMD）、RHTMD、NC和NC/TMD方面存在显著差异（P<0.05）。与RHTMD、NC、TMD和NC/TMD评分相比，MMT（AUC = 0.497；95%置信区间 = CI，0.045 - 0.536）和ULBT（AUC = 0.500，95%CI，0.461 - 0.539）的受试者操作特征曲线（ROC）的主要终点曲线下面积（AUC）较低（[AUC = 0.627，95%CI，0.589 - 0.664]、[AUC = 0.691；95%CI，0.654 - 0.726]、[AUC = 0.606；95%CI，0.567 - 0.643]、[AUC = 0.689；95%CI，0.625 - 0.724]），并且六条ROC曲线的差异具有统计学意义（P<0.05）。
结论
在剖宫产中预测困难喉镜检查方面，NC/TMD与NC、RHTMD和ULBT相比并无优势。
Zotero 插件