超声测量皮肤至会厌距离对困难气道的预测价值

Value of ultrasonic measurement of distance from skin to epiglottis for predicting the difficult airway

目的·评估超声测量皮肤至会厌距离对困难气道的预测价值。方法·选择气管内插管全身麻醉行择期手术的患者71例,年龄20~80岁,ASA分级Ⅰ~Ⅲ级。麻醉前分别进行常规气道评估及超声测量甲状软骨上缘平面皮肤至会厌的距离,比较困难气道与正常气道患者皮肤至会厌的距离,分析困难气道各种评估方法的预测效果。结果·超声左旁矢状位测量困难气道和正常气道患者甲状软骨上缘平面皮肤至会厌的距离分别为(23.31±0.43)mm和(19.21±0.27)mm,差异有统计学意义(P=0.003)。超声测量ROC曲线下面积为0.799(95%CI:0.639~0.958),最佳截点为23.6 mm。与Mallampati分级比较,超声测量的特异度明显增高(96.43%vs71.40%,P=0.004),敏感度的差异无统计学意义(60.00%vs 73.33%,P=0.170)。结论·经左旁矢状位超声测量甲状软骨上缘平面皮肤至会厌的距离可用于预测困难气道。

Objective · To evaluate the value of ultrasonic measurement of distance from skin to epiglottis （DSE） for predicting the difficult airway. Methods · 71 patients （20-80 year-old, ASAⅠ-Ⅲ） undergoing endotracheal intubation and general anesthesia for an elective surgical procedure were enrolled. Conventional airway evaluation was performed. The distance from skin at thyroid cartilage upper edge to epiglottis was measured using ultrasound before anesthesia and compared between patients with difficult airway and normal airway. The effects of different methods for evaluating difficult airway were analyzed .Results · The ultrasonic measurements of DSE on parasagittal view in patients with difficult airway and normal airway were （23.31±0.43） mm and （19.21±0.27） mm, respectively. The difference was statistically significant （P=0.003）. The area under the ROC curve of ultrasonic measurement was 0.799 （95% CI：0.639-0.958） with the best cutoff point of 23.6 mm. The specificity of ultrasonic measurement was significantly increased as compared with Mallampati classification （96.43% vs 71.40%, P=0.004）. The difference in sensitivity was not statistically significant （60.00% vs 73.33%, P=0.170）. Conclusion · Ultrasonic measurement of DSE on parasagittal view can be used to predict the difficult airway.