超声测量应用于OSAHS病人困难喉镜暴露评估

doi:10.16139/j.1007-9610.2024.02.11

摘要/Abstract

摘要：

目的：探讨通过超声测量皮肤到舌骨的距离、皮肤到会厌的距离及皮肤到声带前联合的距离来预测阻塞性睡眠呼吸暂停低通气综合征（OSAHS）病人困难喉镜暴露的可行性。方法：选取择期在气管插管全麻下行悬雍垂腭咽成形术(UPPP)的OSAHS病人150例，ASA分级Ⅰ~Ⅲ级。麻醉前进行常规气道评估（Mallampati分级）及应用超声测量皮肤到舌骨的距离、皮肤到会厌的距离及皮肤到声带前联合的距离。麻醉诱导后采用直接喉镜气管插管，记录喉镜暴露分级，将Cormack-Lehane Ⅲ~Ⅳ级定为喉镜暴露困难。依据喉镜暴露分级的结果将病人分为非困难喉镜暴露组和困难喉镜暴露组，比较两组间Mallampati分级及超声测量值的差异。计算各指标的受试者工作特征曲线(ROC)下面积及超声测量的最佳截点，分析各评估方法对困难喉镜暴露的预测效果。结果：困难喉镜暴露组Mallampati气道分级>Ⅱ级的病例数的比例明显多于非困难喉镜暴露组(P<0.05)。困难喉镜暴露组皮肤到舌骨的距离及皮肤到会厌的距离均明显长于非困难喉镜暴露组(P<0.05)，皮肤到舌骨的距离及皮肤到会厌的距离最佳截点分别为1.12 cm及2.23 cm。皮肤到声带前联合的距离两组差异无统计学意义。结论：超声测量皮肤到舌骨,皮肤到会厌的距离对OSAHS病人困难喉镜暴露具有良好的预测作用。

关键词: 超声测量, 困难气道, 困难喉镜暴露, 阻塞性睡眠呼吸暂停低通气综合征

Abstract:

Objective To explore the feasibility of ultrasonic measurement of the skin to hyoid bone distance, skin to epiglottis distance and skin to anterior commissure of vocal cords distance for predicting difficult laryngoscopy exposure in obstructive sleep apnea hypopnea syndrome(OSAHS) patients. Methods One hundred and fifty OSAHS patients with ASA Ⅰ-Ⅲ level, who underwent elective uvulopalatopharyngoplasty(UPPP) surgery under general anesthesia,were analyzed. Rountine airway assessment (Mallampati classification) and ultrasound measurement of the skin to hyoid bone distance, skin to epiglottis distance and skin to anterior commissure of vocal cords distance were performed before anesthesia. Intubation under direct laryngoscopy and the classification of laryngoscopy exposure was recorded. Cormack-Lehane classification Ⅲ-Ⅳ grade was defined as difficult laryngoscopy exposure. According to the classification results, patients were divided into two groups: non-difficult laryngoscopy exposure group and difficult laryngoscopy exposure group. We analyzed and compared the Malampati grading and ultrasound measurements between two groups. The receiver operating characteristic(ROC) curve and the optimal cut-off point of ultrasonic measurements were calculated. The effects of different methods for predicting difficult laryngoscopy exposure were analyzed. Results The proportion of cases whose Mallampati airway classification grade>Ⅱ in difficult laryngoscopy exposure group was significantly more than that in non-difficult laryngoscopy exposure group (P<0.05).The skin to hyoid bone distance and skin to epiglottis distance in difficult laryngoscopy exposure group were significantly longer than those in non-difficult laryngoscopy exposure group (P<0.05). The optimal cut-off point of the skin to hyoid bone distance and skin to epiglottis distance were 1.12 cm and 2.23 cm respectively. There was no significant difference in the skin to anterior commissure of vocal cords distance between two groups. Conclusion Ultrasound measurement of the skin to hyoid bone distance and skin to epiglottis distance had a good predictive value in difficult laryngoscopy exposure of the OSAHS patients.

Key words: Ultrasonic measurement, Difficult airway, Difficult laryngoscopy exposure, Obstructive sleep apnea hypopnea syndrome(OSAHS)

中图分类号:

R605
R604

李媛媛, 金晨昱, 方舒东, 支延康. 超声测量应用于OSAHS病人困难喉镜暴露评估[J]. 外科理论与实践, 2024, 29(02): 156-160.

LI Yuanyuan, JIN Chenyu, FANG Shudong, ZHI Yankang. Application of ultrasonic measurement in evaluating difficult laryngoscopy exposure of OSAHS patients[J]. Journal of Surgery Concepts & Practice, 2024, 29(02): 156-160.

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Item	Difficult laryngoscopy exposure group（n=29）	Non-difficult laryngoscopy exposure group（n=121）	t/χ² value	P value
Male/female	20/9	75/46	0.33	0.55
Age（years）	37.63±10.86	39.55±11.37	0.82	0.41
Weight(kg)	82.52±7.17	79.29±8.15	1.95	0.05
Body mass index(BMI)	31.15±4.10	29.67±3.61	1.93	0.05
Degree of mouth opening(cm)	4.45±0.58	4.57±0.36	1.41	0.15
Thyromental distance(cm)	6.16±0.33	6.32±0.74	1.13	0.25
Mallampati airway classification grade>Ⅱ[n(%)]	20(68.97)^a)	52(42.98)	4.70	0.03
Upper lip bite test grade>Ⅱ[n(%)]	3(0.10)	5(0.04)	0.08	0.60

Item	Difficult laryngoscopy exposure group（n=29）	Non-difficult laryngoscopy exposure group（n=121）	t value	P value
skin to hyoid bone distance	1.21±0.08^a)	1.03±0.07	12.09	0.00
skin to epiglottis distance	2.40±0.50^a)	2.18±0.42	2.44	0.01
skin to the anterior commissure of vocal cords	0.93±0.15	0.87±0.16	1.83	0.06

Evaluation methods	Sensitivity	Specificity	Optimal cut-off point	Area under the curve (AUC)
Mallampati classification	63.2%	59.1%	grade Ⅱ	64.5%
skin to hyoid bone distance	65.6%	68.1%	1.12 cm	70.4%
skin to epiglottis distance	73.6%	85.1%	2.23 cm	74.0%