喉镜暴露困难的预测系统研究

Predictive system study of difficult laryngoscopy

目的探讨喉镜暴露困难的预测方法。方法选择喉镜暴露困难患者65例(病例组),按照性别与年龄1∶1配对的原则,选择喉镜暴露正常患者65例(对照组),记录两组改良Mallampati分级、上下切牙间距、甲-颏间距、下颌前伸幅度、颈部后仰角度和颈围等。应用条件Logistic回归分析建立预测喉镜暴露困难的新系统,用诊断试验评价的平行(并联)试验评价新预测系统的准确性。结果共4项相关因素按估计优势比(OR)由大到小依次为:上下切牙间距(44.826,95%CI1.317～152.5,P=0.032),颈围(12.458,95%CI1.549～100.179,P=0.033),改良Mallam-pati分级(11.217,95%CI1.223～102.901,P=0.035),下颌前伸幅度(3.390,95%CI1.114～10.316,P=0.018)。新预测系统预测喉镜暴露困难的灵敏度、特异度、阳性预测值和阴性预测值分别是86.2%、63.1%、70.0%和82.0%。结论用上下切牙间距、颈围、改良Mallampati分级和下颌前伸幅度4项因素建立的预测系统可以预测86%的喉镜暴露困难。

Objective A case-control study was carried out to set up a new system for predicting difficult laryngoscopy. Methods The case group consisted of 65 patients in whom a difficult laryngoscopy had occurred. 65 patients who had easy laryngoscopy were paired with the case group in accordance to the principles of the same sex, similar age. Correlative data of two groups were collected and measured in which included modified Mallampati scores, uppe^lower incisor teeth distance, thyromental distance, ability to prognath, neck upward degree and neck circumference. Logistic regression analysis was applied to develop a new effective system for predicting difficult laryngoscopy and to evaluate its accuracy according to the parallel test for diagnostic evaluation. Results Logistic regression analysis showed that the relative risk factors of difficult laryngoscopy were upper-lower incisor teeth distance, neck circumference, modified Mallampati test, ability to prognath. The odd radios （OR） and 95~ confident interval （95%CI） were[44. 826（1. 317±152.5）] （P=0. 032）, [12. 458（1. 549±100. 179）] （P=0. 033）, [11. 217（1. 223±102. 901）] （P=0. 035）, [3. 390 （ 1. 114± 10. 316 ）] （P ： 0. 018） respectively. The sensitivity, specificity, the positive predictive value and the negative predictive value for the new prediction system to predict difficult laryngoscopy were 86.2~, 63.1~/00, 70.0~ and 82.0~ respectively. Conclusion 86~ of difficult laryngoscopy can be predicted by the new prediction system which include upper-lower incisor teeth distance, neck circumference, modified Mallampati test and ability to prognath.