CAJ | 학술논문

目的评价超声法测量颈前软组织厚度对肥胖患者困难喉镜显露的预测价值.方法拟于气管插管全麻下择期手术患者96例,BMI≥28 kg/m2,年龄22 ～ 60岁,性别不限,ASA分级Ⅰ或Ⅱ级.麻醉前分别行改良Mallampati分级评估(M法)和超声法测量颈前软组织厚度评估(U法),颈前超声扫描选择声带水平.设定U法＞20 mm,M法Ⅲ或Ⅳ级为阳性预测标准.麻醉诱导后直接喉镜下以Cormack-Lehane分级Ⅲ或Ⅳ级或无法置入喉镜者定义为困难喉镜显露.计算两种评估方法预测困难喉镜显露的敏感性、特异性和准确率.结果困难喉镜显露患者22例,颈前软组织厚度(23.0±3.0) mm,明显厚于非困难喉镜显露患者[(16.9±2.2) mm] (P＜0.05).U法预测困难喉镜显露的敏感性、特异性和准确率分别为91％、92％和92％,M法预测困难喉镜显露的敏感性、特异性和准确率分别为77％、81％和80％,差异有统计学意义(P＜0.05).U法预测不同性别和年龄患者困难喉镜显露情况各指标比较差异无统计学意义(P＞0.05).结论超声法测量颈前软组织厚度大于20mm可准确地预测肥胖患者困难喉镜显露.
목적 평개초성법측량경전연조직후도대비반환자곤난후경현로적예측개치.방법 의우기관삽관전마하택기수술환자96례,BMI≥28 kg/m2,년령22 ～ 60세,성별불한,ASA분급Ⅰ혹Ⅱ급.마취전분별행개량Mallampati분급평고(M법)화초성법측량경전연조직후도평고(U법),경전초성소묘선택성대수평.설정U법＞20 mm,M법Ⅲ혹Ⅳ급위양성예측표준.마취유도후직접후경하이Cormack-Lehane분급Ⅲ혹Ⅳ급혹무법치입후경자정의위곤난후경현로.계산량충평고방법예측곤난후경현로적민감성、특이성화준학솔.결과 곤난후경현로환자22례,경전연조직후도(23.0±3.0) mm,명현후우비곤난후경현로환자[(16.9±2.2) mm] (P＜0.05).U법예측곤난후경현로적민감성、특이성화준학솔분별위91％、92％화92％,M법예측곤난후경현로적민감성、특이성화준학솔분별위77％、81％화80％,차이유통계학의의(P＜0.05).U법예측불동성별화년령환자곤난후경현로정황각지표비교차이무통계학의의(P＞0.05).결론 초성법측량경전연조직후도대우20mm가준학지예측비반환자곤난후경현로.
Objective To evaluate the value of ultrasound-measured quantification of anterior neck soft tissue in predicting the difficult laryngoscopy in the obese patients.Methods Ninety-six patients,with body mass index ≥ 28 kg/m2,aged 22-60 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia with endotracheal intubation,were selected.Assessment methods of modified Mallampati grade (method M) and anterior neck soft tissue quantification measured by ultrasound (method U) were performed before anesthesia.The level of vocal cords was selected using ultrasound scanning for anterior neck.The positive result was greater than 20 mm in method U,and was grade Ⅲ or Ⅳ in method M.Direct laryngoscope was placed after induction of anesthesia.Difficult laryngoscopy was defined as Cormack-Lehane grade Ⅲ or Ⅳ,or in whom laryngoscope could not be placed.The sensitivity,specificity and accuracy of the two assessment methods for predicting the difficult laryngoscopy were calculated.Results Twenty-two patients were found to have difficult laryngoscopy,and the anterior neck soft tissue quantification was (23.0±3.0) mm,which was significantly thicker than that in the patients of non-difficult laryngoscopy ((1.9±2.2) mm).The sensitivity,specificity and accuracy of method U were 91％,92％ and 92％,respectively,and of method M were 77％,81％ and 80％,respectively,and there was significant difference between the two methods.There was no significant difference in the parameters of difficult laryngoscopy which were predicted using method U between the patients of different ages or gender.Conclusion It can accurately predict the difficult laryngoscopy in the obese patients when the ultrasound-measured quantification of anterior neck soft tissue is greater than 20 mm.