Department of Anesthesiology, Peking University Third Hospital, Peking University Health Science Center, 49 North Garden Road, Haidian District, Beijing, P.R. China.
Department of Radiology, Peking University Third Hospital, Peking University Health Science Center, Beijing, China.
BMC Anesthesiol. 2021 Apr 12;21(1):111. doi: 10.1186/s12871-021-01335-4.
Airway management is one of the most important techniques in anesthesia practice and inappropriate airway management is related with airway injury, brain hypoxia, and even death. The patients with cervical spondylosis are often confronted with difficult laryngoscopy who are more prone to appear difficult airway, so it is important to figure out valuable predictors of difficult laryngoscopy in these patients.
We randomly enrolled 270 patients undergoing elective cervical spine surgery and analyzed the cervical mobility data in predicting difficult laryngoscopy. The preoperative X-ray radiological indicators were measured by an attending radiologist. Cormack-Lehane scales were assessed during intubation, and patients with a class III or IV view were assigned to the difficult laryngoscopy group.
Univariate analysis showed that the hyomental distance (HMD, the distance between the hyoid bone and the tip of the chin) and the hyomental distance ratio (HMDR, the ratio between HMD in the extension position and the one in the neutral position) might not be suitable indicators in patients with cervical spondylosis. Binary multivariate logistic regression (backward-Wald) analyses identified two independent correlative factors from the cervical mobility indicators that correlated best as a predictor of difficult laryngoscopy: modified Mallampati test (MMT) and CCAR (the ratio of the angle between a line passing through the bottom of the second cervical vertebra and a line passing through the bottom of the sixth cervical vertebra in the extension position and the one in the neutral position). The odds ratio (OR) and 95 % CI were 2.292(1.093-4.803) and 0.493 (0.306-0.793), respectively. CCAR exhibited the largest area under the curve (0.714; 95 % CI 0.633-0.794).
CCAR based on preoperative X-ray images may be the most accurate predictor of cervical mobility indicators for difficult laryngoscopy in patients with cervical spondylosis.
The study was registered at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn ; identifier: ChiCTR-ROC-16,008,598) on June 6, 2016.
气道管理是麻醉实践中最重要的技术之一，不当的气道管理与气道损伤、脑缺氧甚至死亡有关。颈椎病患者常面临喉镜检查困难，更容易出现困难气道，因此，找出这些患者中喉镜检查困难的有价值预测指标非常重要。
我们随机招募了 270 名拟行择期颈椎手术的患者，并分析了颈椎活动度数据对喉镜检查困难的预测价值。术前 X 线影像学指标由一名主治放射科医生测量。插管期间进行 Cormack-Lehane 分级，III 级或 IV 级者归入喉镜检查困难组。
单因素分析显示，舌骨-颏下距离（hyomental distance，HMD，舌骨与颏下的距离）和舌骨-颏下距离比（hyomental distance ratio，HMDR，伸展位与中立位 HMD 的比值）在颈椎病患者中可能不是合适的指标。二元多变量逻辑回归（向后 Wald）分析从颈椎活动度指标中确定了两个独立的相关因素，作为喉镜检查困难的最佳预测因子：改良 Mallampati 试验（modified Mallampati test，MMT）和 CCAR（伸展位时通过第二颈椎下缘和第六颈椎下缘的连线与中立位时的连线之间的夹角与中立位时的比值）。比值比（odds ratio，OR）和 95%置信区间（confidence interval，CI）分别为 2.292（1.093-4.803）和 0.493（0.306-0.793）。CCAR 的曲线下面积（area under the curve，AUC）最大，为 0.714（95%CI 0.633-0.794）。
基于术前 X 线图像的 CCAR 可能是预测颈椎病患者喉镜检查困难的最准确的颈椎活动度指标。
该研究于 2016 年 6 月 6 日在中国临床试验注册中心（http://www.chictr.org.cn；注册号：ChiCTR-ROC-16,008,598）注册。
