上唇咬诊试验预测肥胖患者困难气管插管的应用价值研究

Applicational Value of The Upper Lip Bite Test for Predicting Difficult Tracheal Intubation in Obstetric Patients

目的:观察上唇咬诊试验(Upper Lip Bite Test,ULBT)预测肥胖患者困难气管插管的临床应用价值。方法:气管内全麻下行择期外科手术的肥胖患者[体重指数(body mass index,BMI)大于30 kg/m2]200例,参与本研究的麻醉医生分为三组,M组负责术前评估患者的改良的Mallampati分级,U组负责术前评估患者ULBT分级,C组负责评估患者喉镜暴露声门时的Cormack and Lehane分级。改良的Mallampati、Cormack and Lehane、ULBT三类分级中Ⅰ、Ⅱ级视为非困难插管,Ⅲ、Ⅳ级视为困难插管。记录M、U组预测试验的灵敏度、特异性、阳性预测值、阴性预测值和精确度,并进行统计学分析。结果:我们对200例围手术期肥胖患者进行了观测,126例患者改良的Mallampati分级Ⅰ、Ⅱ级,74例Ⅲ、Ⅳ级。177例患者ULBT分级Ⅰ、Ⅱ级,23例Ⅲ级。ULBT在特异性、精确度、阳性预测值三方面均优于改良的Mallampati分级(P<0.05)。灵敏度、阴性预测值两组差异无统计学意义(P>0.05)。结论:ULBT用于肥胖患者围手术期气道评估,方法简单、有效,有一定的临床应用价值。

Objective： To observe the clinical applicational value of the upper hp bite test（ULBT ）tor predicting difficult tracheal intubation in obstetric patients. Methods： 200 obstetric patients with BMI more than 30 kg/m2 undergoing operation were enrolled. The anesthetist in this study were divided into three groups：group M to evaluate preoperative modified Mallampati grading, group U to evaluate preoperative ULBT grading, and group C to evaluate Cormack and Lehane grading when exposing glottis by laryngoscope. In modified Mallampati grading and ULBT grading and Cormack and Lehane grading, the grade Ⅰ andⅡ were considered as easy intubation, grade Ⅲ and Ⅳas difficult intubation. The sensitivity , specificity, positively predictive values , negatively predictive values and accuracy in both groups were recorded and statistically analyzed. Results：Of 200 cases, 126 cases was in gradeⅠ and Ⅱ and 74 in grade Ⅲ and Ⅳ by modified Mallampati grading; 177 cases was in grade Ⅰ and Ⅱand 23 in grade Ⅲ by ULBT grading. ULBT is superior to modified Mallampati grading in specificity, accuracy and positively predictive values（ P 〈 0.05）. There was no difference in sensitivity and negatively predictive values（P 〉 0.05）. Conclusion： ULBT is simple and effective in evaluating the tracheal aspiration in perioperative obstetric patients.