Wu Jinhong, Dong Jing, Ding Yingchun, Zheng Jijian
Department of Anesthesiology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China (mainland).
Department of Diagnostic Ultrasound, Lujiang County People's Hospital, Anhui, China (mainland).
Med Sci Monit. 2014 Nov 18;20:2343-50. doi: 10.12659/MSM.891037.
The aim of this study was to determine if ultrasound (US) measurements of anterior neck soft tissue thickness at hyoid bone (DSHB), thyrohyoid membrane (DSEM), and anterior commissure (DSAC) levels can be used to predict difficult laryngoscopy.
MATERIAL/METHODS: We included 203 patients age 20-65 years scheduled to undergo general anesthesia in this prospective observational study. Correlation analysis and receiver operating characteristic curve (ROC) analysis were used to determine the roles of screening tests [interincisor gap (IIG), thyromental distance (TMD), modified Mallampati score (MMS)] and US measurements (DSHB, DSEM, DSAC) in predicting difficult laryngoscopy.
There were 28 out of 203 patients categorized as difficult laryngoscopy. DSHB, DSEM, DSAC, and MMS were greater in the difficult laryngoscopy group (P<0.0001). There was a strong positive correlation between DSEM and DSHB (r=0.74); moderate positive correlations between DSEM and DSAC (r=0.60), DSHB and DSAC (r=0.69); small positive correlations between MMS and DSHB (r=0.32), MMS and DSEM (r=0.27), MMS and DSAC (r=0.32), all P values £0.0001; very small positive correlation between TMD and IIG (r=0.18, P=0.0089); small negative correlation between IIG and MMS (r=-0.27, P=0.0001); and very small negative correlations between MMS and TMD (r=-0.20, P=0.004), IIG and DSAC (r=-0.18, P=0.011), IIG and DSHB (r=-0.15, P=0.034). The areas under the ROC curve (AUCs) of MMS, DSHB, DSEM, and DSAC were significantly larger compared with the reference line (P<0.0001).
Anterior neck soft tissue thicknesses measured by US at hyoid bone, thyrohyoid membrane, and anterior commissure levels are independent predictors of difficult laryngoscopy. Combinations of those screening tests or risk factors with US measurements might increase the ability to predict difficult laryngoscopy.
本研究旨在确定超声测量舌骨水平（DSHB）、甲状舌骨膜水平（DSEM）和前联合水平（DSAC）的颈部前方软组织厚度是否可用于预测喉镜检查困难。
材料/方法：在这项前瞻性观察研究中，我们纳入了203例年龄在20至65岁之间计划接受全身麻醉的患者。采用相关性分析和受试者操作特征曲线（ROC）分析来确定筛查试验[门齿间距（IIG）、甲颏距离（TMD）、改良Mallampati评分（MMS）]和超声测量值（DSHB、DSEM、DSAC）在预测喉镜检查困难中的作用。
203例患者中有28例被归类为喉镜检查困难。喉镜检查困难组的DSHB、DSEM、DSAC和MMS更大（P<0.0001）。DSEM与DSHB之间存在强正相关（r=0.74）；DSEM与DSAC之间存在中度正相关（r=0.60），DSHB与DSAC之间存在中度正相关（r=0.69）；MMS与DSHB之间存在小正相关（r=0.32），MMS与DSEM之间存在小正相关（r=0.27），MMS与DSAC之间存在小正相关（r=0.32），所有P值均≤0.0001；TMD与IIG之间存在非常小的正相关（r=0.18，P=0.0089）；IIG与MMS之间存在小负相关（r=-0.27，P=0.0001）；MMS与TMD之间存在非常小的负相关（r=-0.20，P=0.004），IIG与DSAC之间存在非常小的负相关（r=-0.18，P=0.011），IIG与DSHB之间存在非常小的负相关（r=-0.15，P=0.034）。与参考线相比，MMS、DSHB、DSEM和DSAC的ROC曲线下面积（AUCs）显著更大（P<0.0001）。
超声测量的舌骨、甲状舌骨膜和前联合水平的颈部前方软组织厚度是喉镜检查困难的独立预测因素。这些筛查试验或危险因素与超声测量值的组合可能会提高预测喉镜检查困难的能力。
