Li Jiao, Tian Yang, Wang Mingya, Fang Jingchao, Zhang Hua, Yue Feng, Xu Mao, Wang Jun, Li Min, Guo Xiangyang, Han Yongzheng
Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, 100191, China.
Department of Radiology, Peking University Third Hospital, Beijing, 100191, China.
BMC Anesthesiol. 2024 Dec 2;24(1):446. doi: 10.1186/s12871-024-02826-w.
Anticipating difficult laryngoscopy is crucial for preoperative assessment, especially for patients with cervical spondylosis. Radiological assessment has become essential for improving airway management safety. This research introduces novel radiological indicators from lateral cervical X-ray in the extended head position proposed to enhance the accuracy of predicting difficult laryngoscopy.
A prospective cohort study included 422 patients scheduled for elective cervical spine surgery. The Cormack-Lehane grades I and II were categorized as "easy laryngoscopy group", while grades III and IV were labeled "difficult laryngoscopy group". Demographic data, conventional bedside indicators including inter-incisor gap (IIG), neck circumference (NC), thyromental distance, the upper lip bite test (ULBT), and 4 radiological indicators including Mandibular Length, Laryngeal Height, the Larynx-Mandibular Angle Test (LMAT) and Larynx-Mandibular Height Test (LMHT) were analyzed comparatively. A binary logistic regression model was developed to identify independent predictive factors. The predictive value of the indicators was evaluated with the area under the curve (AUC).
A total of 402 patients were analyzed in the present study. A binary logistic regression model identified IIG, NC, ULBT, and LMAT as the independent indicators associated with difficult laryngoscopy. A novel combined predictive model equation was derived: Ɩ=-0.969 - 1.33×IIG + 0.408×ULBT + 0.201×NC - 0.042×LMAT. The AUC for this composite model was 0.776, exceeding the individual AUC of 0.677 for LMHT.
LMHT and the novel combined predictive model incorporating LMAT are potentially valuable predictors for difficult laryngoscopy in patients with cervical spondylosis.
The study was registered at the Chinese Clinical Trial Registry (ChiCTR2200058361) on April 7, 2022.
预判困难喉镜检查对于术前评估至关重要，尤其是对于颈椎病患者。影像学评估对于提高气道管理安全性已变得至关重要。本研究从伸展头部位置的颈椎侧位X线片中引入了新的影像学指标，旨在提高预测困难喉镜检查的准确性。
一项前瞻性队列研究纳入了422例计划进行择期颈椎手术的患者。Cormack-Lehane分级I级和II级被归类为“容易喉镜检查组”，而III级和IV级被标记为“困难喉镜检查组”。对人口统计学数据、包括门齿间距（IIG）、颈围（NC）、甲状软骨-颏下距离、上唇咬试验（ULBT）在内的传统床边指标，以及包括下颌长度、喉高度、喉-下颌角试验（LMAT）和喉-下颌高度试验（LMHT）在内的4项影像学指标进行了比较分析。建立了二元逻辑回归模型以确定独立预测因素。用曲线下面积（AUC）评估指标的预测价值。
本研究共分析了402例患者。二元逻辑回归模型确定IIG、NC、ULBT和LMAT为与困难喉镜检查相关的独立指标。得出了一个新的联合预测模型方程：Ɩ=-0.969 - 1.33×IIG + 0.408×ULBT + 0.201×NC - 0.042×LMAT。该复合模型的AUC为0.776，超过了LMHT的个体AUC 0.677。
LMHT以及纳入LMAT的新联合预测模型对于颈椎病患者的困难喉镜检查可能是有价值的预测指标。
该研究于2022年4月7日在中国临床试验注册中心（ChiCTR2200058361）注册。
