喉镜评分预测支撑喉镜手术暴露的临床意义

Clinical significance of laryngoscope scoring system in predicting the laryngeal exposure

目的研究喉镜评分系统对于支撑喉镜手术中声门暴露困难程度的预测作用。方法应用双盲试验方法,测试员用喉镜评分系统对支撑喉镜手术患者进行术前测量及评分,术者在术中对患者声门暴露困难程度进行评估分级,收集数据后统计两者是否具有相关性,及分析主要相关因素。结果当患者术前喉镜评分为6分及以下时,术中82.8%的概率出现可接受喉暴露,17.2%的可能出现困难喉暴露。当患者术前喉镜评分超过6分时,术中100%的概率会出现困难喉暴露。困难喉暴露预测系统(>6分)的灵敏度、特异度、误诊率、漏诊率分别为100%(20/20)、82.8%(48/58)、0%(0/20)、17.2%(10/58)。有统计学意义的变量为:开口牙裂距离、甲状软骨角-颏下距离、颈部伸展角度、体质量指数、小颌畸形。结论利用简易可行的术前支撑喉镜评分系统,将6分作为困难喉暴露与可接受喉暴露的分界,准确度较高,在临床上简单易操作,具有一定的实用性。

Objective To investigate the predictive effect of the laryngoscopy scoring system on cases of difficult glottic exposure during laryngoscopy.Methods This was a double-blind study,in which the laryngoscopy scoring system was used to preoperatively examine and score patients who were undergoing laryngoscopy.The surgeon assessed and graded the difficulty in glottis exposure during the operation,to assess whether it was relevant and could analyze the associated factors.Results When the patient had a preoperative laryngoscope score of≤6,an acceptable laryngeal exposure was observed at an 82.8%probability,while a difficult laryngeal exposure was found at 17.2%.When the patient's preoperative laryngoscopy score exceeded 6,a 100%probability of surgery would lead to difficult laryngeal exposure.The sensitivity,specificity,misdiagnosis,and missed-diagnosis rates of the difficult laryngeal exposure prediction system(>6 points)were 100%(20/20),82.8%(48/58),0%(0/20),and 17.2%(10/58),respectively.Statistically significant variables included open cleavage distance,thyroid cartilage angle-underarm distance,neck extension angle,body mass index,and small jaw deformity.Conclusion Using the simple and feasible preoperative support laryngoscopy scoring system,a threshold of 6 points was used to distinguish cases with difficult laryngeal exposure from those with acceptable laryngeal exposure,with relatively high accuracy.Furthermore,this scoring system proved to be simple and easy to operate in clinical practice and could be certainly considered practicable.