超声测量气道参数预测困难面罩通气的准确性

Accuracy of ultrasound measurement of airway parameters in predicting difficult mask ventilation

目的评价超声测量气道参数预测困难面罩通气(DMV)的准确性。方法择期行气管插管全麻手术患者96例,年龄18~90岁,BMI 16~39 kg/m2,ASA分级Ⅰ或Ⅱ级。术前1 d时行临床气道评估,记录改良Mallampati分级、甲颏间距和上唇咬合试验分级。麻醉诱导前30 min采用超声测量髁状突活动度、舌纵截面积及舌横径,计算舌体积(舌纵截面积与舌横径的乘积)。麻醉诱导后行面罩通气,面罩通气困难分级≥Ⅲ级为DMV,根据是否发生DMV分为2组:非DMV组(NDMV组)和DMV组。将组间差异有统计学意义的临床气道评估指标和超声测量气道参数与DMV行Spearman相关分析;采用受试者工作特征曲线下面积(AUC)评价各指标预测DMV的准确性,确定临界值,计算准确率、灵敏度、特异度、阳性预测值和阴性预测值。结果改良Mallampati分级、上唇咬合试验分级、舌纵截面积、舌横径、舌体积与DMV呈正相关,甲颏间距和髁状突活动度呈负相关(P<0.05)。超声测量髁状突活动度和舌体积预测DMV的AUC分别为0.898、0.862,界值分别为1.19 cm、99.94 cm^(3),灵敏度均>70%,特异度均>90%,阳性预测值分别为92.31%、88.46%。结论超声测量髁状突活动度和舌体积可准确预测DMV。

Objective To evaluate the accuracy of ultrasound measurement of airway parameters in predicting difficult mask ventilation(DMV).Methods Ninety-six patients,aged 18-90 yr,with body mass index of 16-39 kg/m2,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,undergoing elective endotracheal intubation under general anesthesia,were included in this study.Clinical airway evaluation was performed at 1 day before surgery,and modified Mallampati classification,thyromental distance and rating of the upper lip bite test were recorded.At 30 min before anesthesia induction,mandibular condylar motion,tongue longitudinal cross-sectional area and transverse diameter of tongue were measured by ultrasound,and the tongue volume(product of tongue longitudinal cross-sectional area and transverse diameter of tongue)was calculated.Mask ventilation was performed after induction of anesthesia,mask ventilation difficulty grade≥Ⅲwas defined as DMV,the patients were divided into 2 groups according to whether DMV occurred:non-DMV group(NDMV group)and DMV group.Correlations between the clinical airway evaluation indexes and ultrasonic airway parameters with statistically significant differences between groups and DMV were assessed using Spearman′s rank correlation.The area under the receiver operating characteristics curve was used to evaluate the accuracy of each parameter in predicting DMV,the critical value was determined,and the accuracy,sensitivity,specificity,positive and negative predictive values were calculated.Results The modified Mallampati classification,rating of the upper lip bite test,ultrasonic tongue longitudinal cross-sectional area,transverse diameter of tongue and tongue volume were positively correlated with DMV,and thyromental distance and mandibular condylar motion were negatively correlated with DMV(P<0.05).The area under the receiver operating characteristics curve of mandibular condylar motion and tongue volume in predicting DMV were 0.898 and 0.862,respectively,the cut-off values were 1.19 cm and 99.94 cm^(3),respectively,and the sensitivity and specificity were all over 70%and 90%,respectively,the positive predictive values were 92.31%and 88.46%,respectively.Conclusions Ultrasonic measurements of mandibular condylar motion and tongue volume can accurately predict DMV.