摘要
目的：探索一种更全面、有效的困难气道预测评估新体系。方法：选择450例口腔颌面及整形外科手术患者。根据临床需要选择在快速诱导下使用直接喉镜插管或清醒状态下使用盲探气管插管装置插管。对清醒插管者，在插管完成后再给予进行麻醉诱导。以直接喉镜下所观察的Cormack-Lehane喉头分级结果作为设定“插管困难”标准的依据。对快速诱导插管者，可在诱导用药后、插管前观察；对清醒插管者，需在插管和诱导用药后观察。插管困难的标准为Cormack-Lehane喉头Ⅲ级、Ⅳ级或无法置入直接喉镜。应用Logistic回归分析插管困难的各种可能影响因素，包括病史、年龄、体重指数、上下切牙间距离、下颌骨水平长度、下颌骨宽度、颏至甲状软骨间距离、深覆盖、颈长、颈围、颈部后仰度、Mallampati试验。采用X^2检验进行敏感性、特异性、误诊率和漏诊率的比较。结果：①与困难插管可能相关的12项指标中，应用多因素回归分析得出8项阳性相关因素，按估计相对危险度（OR）由大到小依次为：体重指数[5．64（3．51-8．12）]、上下切牙间距离[4．57（2．79-11．55）]、颏至甲状软骨间距离[4．35（2．33-6．97）]、病史[4．09（1．26-7．62）]、Mallampati试验[3．79（1．95-9．20）]、下颌骨水平长度[3．52（2．48-6．90）]、颈部后仰度[3．05（1．16-8．51）]、颈围[2．79（1．35-4．96）]（P〈0．05）。②根据阳性相关因素，设定相应评分，建立所需的困难气道预测评估体系。将已得出的8项相关因素作为预测指标，每项分别设为1-3分，总分23分，分数越大，发生插管困难的危险性越大。③新预测评估体系具有敏感性高（93．3％）、漏诊率低（6．7％）的特点，明显优于Mallampati试验、wilson评分（P〈0.05）。结论：新的困难气道预测评估体系应用于术前气道评估更为全面、有效，可大大提高对困难气道预测的准确性。
Objective：To set up an effective prediction model for difficult airway. Methods：Totally, 450 cases of oral maxillofacial or plastic surgery were enrolled. Multivariate logistic regression methods were used to explore the potential risk factors of difficult airway. The possible relative factors were healthy history, age, body mass index, upper-lower incisor teeth distance, mandibular length, mandibular width, thyroid-mentum distance, deep overbite, neck length ,neck circumference, neck upward degree and Mallampati test. The standard of difficult intubation was Cormack Lehane classes Ⅲ（Ⅳ and difficulty inserting a laryngoscope. Results： The relative factors of difficult intubation were body mass index, upper-lower incisor teeth distance, thyroid-mentum distance, history, Mallampati test, mandibular length, neck upward degree, neck circumference. The odd radios （OR） and 95% confident interval （95%CI） were 5.64（3. 51-8.12）,4.57（2.79-11.55）,4.35（2.33-6.97）,4.09（1.26-7.62） ,3.79（1.95-9.20） ,3.52（2.48 -6.90）,3.05（1.16-8.51）, and 2.79（1.35-4.96） respectively. The variables included in the predicting model were difficult intubation, including the eight relative factors with 2 score or 3 score each factor, altogether 23 score, the higher score,the more risks. The new assessment system had higher sensitivity （93.3%）and lower misdiagnosis rate （6.7%）（P〈0.05）, comparing with Mallampati test and Wilson score, Conclusion： The new assessment system is an effective method for predicting difficult airway. It can help to increase predicting accuracy.
出处
《中国临床医学》
北大核心
2008年第4期540-542,共3页
Chinese Journal of Clinical Medicine
基金
上海市卫生局科研基金(054051)
关键词
围术期
气道困难
预测
Perioperation period
Difficult airway
Prediction
