最大髁突-耳垂距离评估可预测无需暴露上呼吸道的困难气道管理；一项前瞻性观察研究。

The evaluation of maximum condyle-tragus distance can predict difficult airway management without exposing upper respiratory tract; a prospective observational study.

机构信息

Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China.

Department of Oncology, First Affiliated Hospital of the University of Science and Technology of China, Provincial Cancer Hospital, Hefei, Anhui, China.

出版信息

BMC Anesthesiol. 2021 Jan 25;21(1):28. doi: 10.1186/s12871-021-01253-5.

DOI:10.1186/s12871-021-01253-5

PMID:33494705

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7829489/

Abstract

BACKGROUND

Routine preoperative methods to assess airway such as the interincisor distance (IID), Mallampati classification, and upper lip bite test (ULBT) have a certain risk of upper respiratory tract exposure and virus spread. Condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic.

METHODS

Adult patients undergoing general anesthesia and tracheal intubation were enrolled. IID, Mallampati classification, ULBT, and C-TMD of each patient were evaluated before the initiation of anesthesia. The primary outcome was intubation time. The secondary outcomes were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts.

RESULTS

Three hundred four patients were successfully enrolled and completed the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD>1 finger group 46.8 ± 7.3 s, compared with the C-TMD<1 finger group 50.8 ± 8.6 s (p<0.01). First attempt success rate was higher in the C-TMD>1 finger group 98.9% than in the C-TMD<1 finger group 87.1% (P<0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317 (Spearman correlation coefficient, P<0.001), and the area under the ROC curve was 0.699 (P<0.01). The C-TMD < 1 finger width was the most consistent with difficult laryngoscopy (κ = 0.485;95%CI:0.286-0.612) and its OR value was 10.09 (95%CI: 4.19-24.28), sensitivity was 0.469 (95%CI: 0.325-0.617), specificity was 0.929 (95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847 (95%CI: 0.825-0.865).

CONCLUSION

Compared with the IID, Mallampati classification and ULBT, C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract.

TRIAL REGISTRATION

The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry ( ChiCTR1900026775 ).

摘要

背景

常规的术前评估气道的方法，如切牙间距（IID）、Mallampati 分级和上唇咬测试（ULBT），都有一定的上呼吸道暴露和病毒传播的风险。髁突-耳屏最大距离（C-TMD）可用于评估气道，且不需要患者暴露上呼吸道，但与其他指标（Mallampati 分级、IID 和 ULBT）相比，其在预测困难喉镜检查方面的价值尚不清楚。本研究旨在观察 C-TMD 预测困难喉镜检查的价值以及对插管时间和插管尝试次数的影响，为疫情期间的术前气道评估提供新思路。

方法

纳入行全身麻醉和气管插管的成年患者。在麻醉开始前评估每位患者的 IID、Mallampati 分级、ULBT 和 C-TMD。主要结局是插管时间。次要结局是定义为 Cormack-Lehane 分级>2 级的困难喉镜检查和插管尝试次数。

结果

304 例患者成功入组并完成研究，39 例患者被确定为困难喉镜检查。C-TMD>1 指组的插管时间为 46.8±7.3 s，明显短于 C-TMD<1 指组的 50.8±8.6 s（p<0.01）。C-TMD>1 指组的首次尝试成功率为 98.9%，明显高于 C-TMD<1 指组的 87.1%（P<0.01）。C-TMD 与 Cormack-Lehane 分级的相关性为 0.317（Spearman 相关系数，P<0.001），ROC 曲线下面积为 0.699（P<0.01）。C-TMD<1 指宽与困难喉镜检查最一致（κ=0.485；95%CI：0.286-0.612），其 OR 值为 10.09（95%CI：4.19-24.28），灵敏度为 0.469（95%CI：0.325-0.617），特异性为 0.929（95%CI：0.877-0.964），阳性预测值为 0.676（95%CI：0.484-0.745），阴性预测值为 0.847（95%CI：0.825-0.865）。