仰卧位和站立位时发声与不发声状态下的马兰帕蒂试验在预测困难喉镜检查和插管中的比较：一项前瞻性研究。
A comparison of the Mallampati test in supine and upright positions with and without phonation in predicting difficult laryngoscopy and intubation: A prospective study.
作者信息
Khan Zahid Hussain, Eskandari Shahram, Yekaninejad Mir Saeed
机构信息
Department of Anesthesiology and Intensive Care, Imam Khomeini Medical Center, Tehran, Iran.
Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
J Anaesthesiol Clin Pharmacol. 2015 Apr-Jun;31(2):207-11. doi: 10.4103/0970-9185.155150.
BACKGROUND AND AIMS
Difficult ventilation and intubation have been recognized as the forerunners of hypoxic brain damage during anesthesia. To overcome catastrophic events during anesthesia, an assessment of the airway before induction is of paramount importance. We designed this study to compare the effect of phonation on the Mallampati test in supine and upright positions as against the traditionally employed test without phonation in serving to predict difficult laryngoscopy and intubation.
MATERIAL AND METHODS
In this cross-sectional study, 661 patients aged 16-60 years were recruited during the years 2011 to 2012. The Mallampati test was conducted on patients with and without phonation in both the sitting and supine positions. A blinded observer then performed laryngoscopy and intubation. Difficult intubation was assessed according to the Cormack-Lehane Grading scale.
STATISTICAL ANALYSIS USED
Diagnostic statistical measures for each of the four situations - sensitivity, specificity, positive and negative predictive values and accuracy - were calculated.
RESULTS
In this study, 28 patients (4.2%) had difficult laryngoscopy and nine patients (1.4%) had difficult intubation. There was no difference in the sensitivity of the Mallampati test as regards prediction of laryngoscopy and intubation in the four different positions, but the upright position along with phonation had the highest specificity. The negative predictive value was above 95% in all the positions; however, the positive predictive value was the highest in the supine position along with phonation.
CONCLUSION
Based on our results, the supine position along with phonation had the best correlation in the prediction of difficult laryngoscopy and intubation. We further conclude that phonation significantly improved the Mallampati class in the supine position compared with the upright position.
背景与目的
困难通气和插管已被视为麻醉期间缺氧性脑损伤的先兆。为了避免麻醉期间发生灾难性事件，诱导前对气道进行评估至关重要。我们设计了本研究，以比较发声对仰卧位和直立位马兰帕蒂试验的影响，与传统的不发声试验相比，观察其预测困难喉镜检查和插管的效果。
材料与方法
在这项横断面研究中，2011年至2012年招募了661名年龄在16至60岁之间的患者。对患者在坐位和仰卧位时发声和不发声两种情况下进行马兰帕蒂试验。然后由一名不知情的观察者进行喉镜检查和插管。根据科马克-莱汉内分级量表评估困难插管情况。
所用统计分析方法
计算了四种情况（敏感性、特异性、阳性和阴性预测值以及准确性）下的诊断统计指标。
结果
在本研究中，28例患者（4.2%）喉镜检查困难，9例患者（1.4%）插管困难。在四种不同体位下，马兰帕蒂试验对喉镜检查和插管预测的敏感性没有差异，但直立位发声时特异性最高。所有体位下的阴性预测值均高于95%；然而，仰卧位发声时阳性预测值最高。
结论
根据我们的研究结果，仰卧位发声在预测困难喉镜检查和插管方面具有最佳相关性。我们进一步得出结论，与直立位相比，发声在仰卧位时显著改善了马兰帕蒂分级。
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