坐位与仰卧位时Mallampati分级预测困难气管插管的比较：一项前瞻性观察队列研究。
Comparison of the Mallampati Classification in Sitting and Supine Position to Predict Difficult Tracheal Intubation: A Prospective Observational Cohort Study.
作者信息
Hanouz Jean-Luc, Bonnet Vincent, Buléon Clément, Simonet Thérèse, Radenac Dorothée, Zamparini Guillaume, Fischer Marc Olivier, Gérard Jean-Louis
机构信息
From the Department of Anesthesiology and Intensive Care, University Hospital of Caen, Caen, France.
University Caen Normandie, Caen, France.
出版信息
Anesth Analg. 2018 Jan;126(1):161-169. doi: 10.1213/ANE.0000000000002108.
BACKGROUND
The Mallampati classification (MLPT) is normally evaluated in the sitting position. However, many patients cannot be evaluated in the sitting position for medical reasons. Thus, we compared the MLPT in sitting and supine positions in predicting difficult tracheal intubation (DTI). We hypothesized that the diagnostic accuracy of the MLPT performed in sitting and supine positions would differ.
METHODS
We performed a single-center prospective observational study in adult patients who received general anesthesia and orotracheal intubation for noncardiac surgery. During the preanesthesia consultation, the MLPT in the sitting position was recorded. The day of surgery, the MLPT in the supine position and the difficulty of intubation (DTI) were recorded by an independent observer. The diagnostic performance of the MLPT for the prediction of DTI was evaluated in the sitting and supine positions through the area under the receiver operating characteristic (ROC) curve. The performance of the Naguib score in predicting DTI was calculated with the MLPT in sitting and supine positions.
RESULTS
Among the 3036 patients, 157 (5.1%) had DTI. The area under the ROC curve for the MLPT in supine position (0.82 [0.78-0.84]) was greater than that for the MLPT in the sitting position (0.70 [0.66-0.75]; P < .001). The relationship between the sitting and supine MLPTs was moderate (Spearman rank correlation coefficient: 0.50; P < .001). The area under ROC curve for predicting DTI by the Naguib score calculated with the supine MLPT (0.78 [95% confidence interval, 0.74-0.82]) was greater than that for the Naguib score calculated with MLPT in the sitting position (0.69 [95% confidence interval, 0.63-0.74)]; P < .001).
CONCLUSIONS
The MLPT performed in the supine position is possibly superior to that performed in the sitting position for predicting difficult intubation in adults.
背景
Mallampati分级（MLPT）通常在坐位下进行评估。然而，由于医学原因，许多患者无法在坐位下进行评估。因此，我们比较了坐位和仰卧位的MLPT在预测困难气管插管（DTI）方面的情况。我们假设在坐位和仰卧位进行的MLPT的诊断准确性会有所不同。
方法
我们对接受非心脏手术全身麻醉和经口气管插管的成年患者进行了一项单中心前瞻性观察研究。在麻醉前会诊期间，记录坐位下的MLPT。手术当天，由一名独立观察者记录仰卧位下的MLPT和插管难度（DTI）。通过受试者操作特征（ROC）曲线下面积评估坐位和仰卧位下MLPT对DTI预测的诊断性能。计算坐位和仰卧位下Naguib评分预测DTI的性能。
结果
在3036例患者中，157例（5.1%）发生DTI。仰卧位MLPT的ROC曲线下面积（0.82[0.78 - 0.84]）大于坐位MLPT的ROC曲线下面积（0.70[0.66 - 0.75]；P <.001）。坐位和仰卧位MLPT之间的关系为中度（Spearman等级相关系数：0.50；P <.001）。仰卧位MLPT计算的Naguib评分预测DTI的ROC曲线下面积（0.78[95%置信区间，0.74 - 0.82]）大于坐位MLPT计算的Naguib评分的ROC曲线下面积（0.69[95%置信区间，0.63 - 0.74]；P <.001）。
结论
对于预测成人困难插管，仰卧位进行的MLPT可能优于坐位进行的MLPT。
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