Eiamcharoenwit J, Itthisompaiboon N, Limpawattana P, Suwanpratheep A, Siriussawakul A
Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand.
Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.
Int J Obstet Anesth. 2017 May;31:45-50. doi: 10.1016/j.ijoa.2017.01.011. Epub 2017 Feb 5.
Pregnancy and obesity each increase the chance of difficult tracheal intubation. This study assessed the performance of the neck circumference and other bedside tests in predicting difficult intubation, and aimed to identify the optimal cutoff point of the test(s) with the highest performance.
Parturients with a body mass index ≥30kg/m, undergoing a cesarean delivery employing conventional tracheal intubation, were enrolled. Preoperative neck circumference, sternomental distance and modified Mallampati test were examined. Difficult intubation was defined as intubation difficulty scale score ≥5.
Five hundred and seventy parturients of mean body mass index 34.1 (±SD 3.8) kg/m were recruited. The incidence of difficult intubation was 3.5%. The performance of the neck circumference test, conducted with the patient sitting or supine, and using the area under the receiver operating characteristic (ROC) curves, was 0.6 (95% CI 0.5 to 0.7) and 0.6 (95% CI 0.4 to 0.7) respectively. The area under the ROC for the modified Mallampati test was 0.6 (95% CI 0.5 to 0.7) and for the sternomental distance test was 0.7 (95% CI 0.6 to 0.8). A sternomental distance less than 14.5cm, and a ratio of neck circumference in the sitting position to sternomental distance of greater than or equal to 2.7, were optimal cutoff points to identify difficult intubation.
The neck circumference, the sternomental distance, the modified Mallampati test and the ratio of neck circumference to the sternomental distance show limited performance as screening tests to predict difficult intubation among obese parturients.
妊娠和肥胖均会增加气管插管困难的几率。本研究评估了颈围及其他床旁检查在预测插管困难方面的表现，旨在确定具有最高预测效能的检查的最佳截断点。
纳入体重指数≥30kg/m²且采用传统气管插管行剖宫产的产妇。术前检查颈围、胸骨上切迹至颏下距离及改良马兰帕蒂试验。插管困难定义为插管困难量表评分≥5分。
招募了570例平均体重指数为34.1（±标准差3.8）kg/m²的产妇。插管困难发生率为3.5%。患者坐位或仰卧位时进行颈围检查，采用受试者工作特征（ROC）曲线下面积评估，其预测效能分别为0.6（95%可信区间0.5至0.7）和0.6（95%可信区间0.4至0.7）。改良马兰帕蒂试验的ROC曲线下面积为0.6（95%可信区间0.5至0.7），胸骨上切迹至颏下距离检查的ROC曲线下面积为0.7（95%可信区间0.6至0.8）。胸骨上切迹至颏下距离小于14.5cm以及坐位时颈围与胸骨上切迹至颏下距离之比大于或等于2.7是识别插管困难的最佳截断点。
颈围、胸骨上切迹至颏下距离、改良马兰帕蒂试验以及颈围与胸骨上切迹至颏下距离之比作为预测肥胖产妇插管困难的筛查检查，其预测效能有限。
