Badheka Jigisha Prahladrai, Doshi Pratik M, Vyas Ashutosh M, Kacha Nirav Jentilal, Parmar Vandana S
Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India.
Indian J Crit Care Med. 2016 Jan;20(1):3-8. doi: 10.4103/0972-5229.173678.
Various anatomical measurements and noninvasive clinical tests, singly or in various combinations can be performed to predict difficult intubation. Upper lip bite test (ULBT) and ratio of height to thyromental distance (RHTMD) are claimed to have high predictability. Hence, we have conducted this study to compare the predictive value of ULBT and RHTMD with the following parameters: Mallampati grading, inter-incisor gap, thyromental distance, sternomental distance, head and neck movements, and horizontal length of mandible for predicting difficult intubation.
In this single blinded, prospective, observational study involving 170 adult patients of either sex belonging to American Society of Anesthesiologists physical Status I-III scheduled to undergo general anesthesia were recruited. All patients were subjected to the preoperative airway assessment and, the above parameters were recorded correlated with Cormack and Lehane grade and analyzed. The number of intubation attempts and use of intubation aids were also noted.
ULBT and RHTMD had highest sensitivity (96.64%, 90.72%), specificity (82.35%, 80.39%), positive predictive value (92.74%, 91.53%), and negative predictive value (91.3%, 78.8%), respectively, compared to other parameters. While odds ratio and likelihood ratio >1 for all the tests.
ULBT can be used as a simple bedside screening test for prediction of difficult intubation, but it should be combined with other airway assessment tests for better airway predictability. RHTMD can also be used as an acceptable alternative.
可以单独或采用各种组合方式进行多种解剖学测量和无创临床检查，以预测困难插管。上唇咬试验（ULBT）和身高与甲颏距离比值（RHTMD）据称具有较高的预测性。因此，我们开展了本研究，以比较ULBT和RHTMD与以下参数在预测困难插管方面的预测价值：马兰帕蒂分级、门齿间距、甲颏距离、胸骨颏距离、头颈部活动度以及下颌骨水平长度。
在这项单盲、前瞻性观察性研究中，招募了170例计划接受全身麻醉、美国麻醉医师协会身体状况分级为I-III级的成年患者，男女不限。所有患者均接受术前气道评估，并记录上述参数，将其与科马克和莱汉分级进行关联并分析。同时记录插管尝试次数和插管辅助工具的使用情况。
与其他参数相比，ULBT和RHTMD的敏感性最高（分别为96.64%、90.72%），特异性最高（分别为82.35%、80.39%），阳性预测值最高（分别为92.74%、91.53%），阴性预测值最高（分别为91.3%、78.8%）。而所有检查的优势比和似然比均>1。
ULBT可作为预测困难插管的一种简单床旁筛查试验，但应与其他气道评估试验相结合，以获得更好的气道预测性。RHTMD也可作为一种可接受的替代方法。
