支撑喉镜声门区暴露困难影响因素的logistics分析

Logistic Analysis of Influencing Factors of Glottic Exposure Difficulty in Support Laryngoscope

目的探讨支撑喉镜声门区暴露困难的影响因素。方法选取2017年5月~2018年10月医院收治的210例在支撑喉镜下行喉部手术患者作为受试对象,根据术中声门区暴露情况分为非声门区暴露困难组(113例),声门区暴露困难组(97例)。术前收集患者性别、年龄、体质指数(BMI)、颈围、改良Mallampati分级、下颌骨甲状软骨间夹角(TMA)、张口度、颈部屈伸度、舌颏距(HMD)、胸颏距(SMD)、甲颏距(TMD)、垂直甲颏距(VTMD)、水平甲颏距(HTMD)等资料,采用Logistics回归分析声门区暴露困难的影响因素。结果单因素分析中性别(χ2=0.485,P>0.05)、改良Mallampati分级(χ2=2.751,P>0.05)、年龄(t=1.723,P>0.05)、BMI(t=1.508,P>0.05)、SMD(t=1.926,P>0.05)均与术中声门区暴露困难无关(P>0.05),颈围(t=4.172,P<0.001)、TMA(t=8.444,P<0.001)、张口度(t=2.635,P=0.009)、颈部屈伸度(t=4.261,P<0.001)、HMD(t=2.471,P=0.014)、TMD(t=8.488,P<0.001)、VTMD(t=4.683,P<0.001)、HTMD(t=2.724,P=0.007)均与术中声门区暴露困难有关(P<0.05).Logistic多因素分析显示,TMA(OR=6.393,95%CI=2.158~18.941,P<0.001)、颈部屈伸度(OR=4.243,95%CI=1.754~10.266,P<0.001)与TMD(OR=4.533,95%CI=1.349~15.234,P=0.002)均是影响术中声门区暴露困难的危险因子。采用ROC曲线研究3个独立危险指标(TMA、颈部屈伸度与TMD)的诊断价值提示,TMA、颈部屈伸度与TMD的AUC(曲线下面积)均>0.7,TMA≤117°、TMD≤6.5cm及颈部曲伸度≤100.5°被预测为声门区暴露困难,其预测灵敏度分别为88.5%、87.6%、66.4%,特异度分别为57.7%、55.7%、71.1%。结论支撑喉镜术前测量患者TMA、颈部屈伸度与TMD值,可在一定程度上预测术中声门区暴露难易程度,以制定最佳手术方案,提高手术质量。

Objective To explore the influencing factors of glottic exposure difficulty in support la⁃ryngoscope.Methods 210 patients who underwent laryngeal surgery under support laryngoscope from November 2016 to November 2018 were selected as subjects,and were divided into non⁃glottic exposure difficulty group(113 cases)and glottic exposure difficulty group(97 cases).The data of sex,age,body mass index(BMI),neck circumference,improved Mallampati classification,mandibular thyroid carti⁃lage angle(TMA),mouth opening,neck flexion and extension,tongue⁃chin distance(HMD),chest⁃chin distance(SMD),nail⁃chin distance(TMD),vertical nail⁃chin distance(VTMD),horizontal nail⁃chin distance(HTMD)of patients were collected before operation,Logistic regression was used to ana⁃lyze the influencing factors of glottic exposure difficulty.Results In univariate analysis,gender(χ2=0.485,P>0.05),modified Mallampati classification(χ2=2.751,P>0.05),age(t=1.723,P>0.05),BMI(t=1.508,P>0.05)and SMD(t=1.926,P>0.05)were not associated with intraoperative glottic ex⁃posure difficulty(P>0.05),cervical circumference(t=4.172,P<0.001),TMA(t=8.444,P<0.001),mouth opening(t=2.635,P=0.009),neck flexion and extension(t=4.261,P<0.001),HMD(t=2.471,P=0.014),TMD(t=8.488,P<0.001),VTMD(t=4.683,P<0.001)and HTMD(t=2.724,P=0.007)were all associated with intraoperative difficulty in glottic exposure(P<0.05).Logistic multivariate analy⁃sis showed that TMA(OR=6.393,95%CI=2.158⁃18.941,P<0.001),neck flexion and extension(OR=4.243,95%CI=1.754⁃10.266,P<0.001),and TMD(OR=4.533,95%CI=1.349⁃15.234,P=0.002)were risk factors for intraoperative glottic exposure difficulty(P<0.05).ROC curve was used to study the diagnostic value of three independent risk indicators(TMA,neck flexion and extension,and TMD),the AUC of TMA,neck flexion and extension and TMD were all>0.7,TMA≤117°,TMD≤6.5cm and neck flexion and extension≤100.5°were predicted as glottis exposure difficulty,the predicted sensitivity was 88.5%,87.6%and 66.4%,and the specificity was 57.7%,55.7% and 71.1%,respectively.Conclu⁃sion Preoperative measurement of TMA,neck flexion and extension,and TMD by support laryngo⁃scope can predict the degree of intraoperative exposure of glottic region to a certain extent,so as to for⁃mulate the best surgical plan and improve the quality of surgery.