Han Yong-Zheng, Tian Yang, Xu Mao, Ni Cheng, Li Min, Wang Jun, Guo Xiang-Yang
Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China.
BMC Anesthesiol. 2017 Apr 4;17(1):55. doi: 10.1186/s12871-017-0346-y.
Preoperative airway assessment help anticipate a difficult airway. We hypothesized that a close association existed between difficult laryngoscopy and the neck circumference/inter-incisor gap ratio (RNIIG). Our aim was to determine its utility in predicting difficult laryngoscopy in cervical spondylosis patients.
Two hundred thirteen consecutive patients, aged 20-70 years, scheduled to undergo cervical spine surgery under general anesthesia, were recruited. Preoperative assessments included inter-incisor gap (IIG), thyromental distance (TMD), neck circumference (NC), NC/IIG ratio (RNIIG), NC/TMD ratio (RNTMD) and modified Mallampati test (MMT). Cormack-Lehane scales were assessed during intubation. The anesthesiologist was blinded to the airway assessments. RNIIG's ability to predict difficult laryngoscopy was compared with that of established predictors.
Difficult laryngoscopy incidence was 16.4%. Univariate analysis showed that male gender, increased age, weight, NC, RNIIG and RNTMD, decreased IIG and TMD, and MMT 3 and 4 were associated with difficult laryngoscopy. Binary multivariate logistic regression analyses identified only one factor that was independently associated with difficult laryngoscopy: RNIIG. The odds ratio and 95% confidence interval (95% CI) were 1.932 (1.504-2.482). RNIIG (≥9.5) exhibited the largest area under the curve (0.80; 95% CI 0.73-0.86) and the highest sensitivity (88.6%; 95% CI 78.1-99.1) and negative predictive value (96.6%; 95% CI 94.0-99.2), confirming its better predictive ability.
RNIIG is a new and simple predictor with a higher level of efficacy, and could help anesthetists plan for difficult laryngoscopy management in cervical spondylosis patients.
ChiCTR-OON-16008320 (April 19th, 2016).
术前气道评估有助于预判困难气道。我们推测喉镜检查困难与颈围/上门齿间隙比值（RNIIG）之间存在密切关联。我们的目的是确定其在预测颈椎病患者喉镜检查困难方面的效用。
招募了连续213例年龄在20至70岁之间、计划在全身麻醉下接受颈椎手术的患者。术前评估包括上门齿间隙（IIG）、甲状软骨-颏距离（TMD）、颈围（NC）、NC/IIG比值（RNIIG）、NC/TMD比值（RNTMD）和改良马兰帕蒂试验（MMT）。在插管期间评估科马克-莱汉内分级。麻醉医生对气道评估结果不知情。将RNIIG预测喉镜检查困难的能力与既定预测指标的能力进行比较。
喉镜检查困难发生率为16.4%。单因素分析显示，男性、年龄增加、体重、颈围、RNIIG和RNTMD增加，IIG和TMD降低，以及MMT 3级和4级与喉镜检查困难相关。二元多因素逻辑回归分析仅确定了一个与喉镜检查困难独立相关的因素：RNIIG。比值比和95%置信区间（95%CI）为1.932（1.504 - 2.482）。RNIIG（≥9.5）的曲线下面积最大（0.80；95%CI 0.73 - 0.86），敏感性最高（88.6%；95%CI 78.1 - 99.1），阴性预测值最高（96.6%；95%CI 94.0 - 99.2），证实其具有更好的预测能力。
RNIIG是一种新的、简单的预测指标，具有较高的效能，可帮助麻醉医生为颈椎病患者的困难喉镜检查管理制定计划。
ChiCTR - OON - 16008320（2016年4月19日）。
