超声测量不同气道指标预测患儿喉镜暴露困难的价值

目的评价超声进行气道评估对患儿喉镜暴露困难的预测价值。方法选择需行气管插管全身麻醉的择期手术患儿287例,男194例,女93例,年龄5～12岁,BMI 10～29 kg/m~2。根据年龄和喉镜暴露情况分为四组:5～8岁喉镜暴露困难组(DL5组)和9～12岁喉镜暴露困难组(DL9组)、5～8岁喉镜暴露容易组(EL5组)和9～12岁喉镜暴露容易组(EL9组)。记录术前改良Mallampati分级、张口度和甲颏间距,麻醉诱导前采用超声测量患儿舌纵截面积、舌宽度、颏舌骨肌长度和皮肤到会厌的距离,并计算出舌体积。采用ROC曲线评估超声测量指标预测喉镜暴露困难的有效性。结果 287例患儿中,喉镜暴露困难13例(4.53%)。5～12岁患儿改良Mallampati分级增加、5～8岁患儿张口度缩小、9～12岁患儿甲颏间距缩短对其喉镜暴露困难都有较好的预测作用;超声颏舌骨肌长度缩短(5～8岁,3.85 cm; 9～12岁,4.19 cm)和皮肤到会厌的距离增加(5～8岁,1.56 cm)都能较好地预测患儿喉镜暴露困难,以上指标ROC曲线下面积(AUC)均在0.7～0.9。结论超声测量颏舌骨肌长度和皮肤到会厌的距离均可有效预测患儿喉镜暴露困难。

The value of ultrasound evaluation in predicting difficult laryngoscopy in children

Objective To study the predictive value of airway assessment under ultrasound for difficult laryngoscopy in children.
Methods A total of 287 children, 194 males and 93 females, aged 5-12 years, BMI 10-29 kg/m², undergoing general anesthesia and endotracheal intubation were enrolled. Children were divided into four groups according to age and the condition of laryngoscope exposure: 5 to 8 years old with difficult laryngoscope exposure group (group DL5), 9 to 12 years old with difficult laryngoscope exposure group (group DL9), 5 to 8 years old with easy laryngoscope exposure group (group EL5) and 9 to 12 years old with easy laryngoscope exposure group (group EL9). Before operation, the results of clinical airway assessments were collected: modified Mallampati score, inter-incisor distance and thyromental distance. Before anesthesia, the tongue longitudinal cross-sectional area, the tongue width, the length of geniohyoid muscle, and the distance from skin to epiglottis were measured by ultrasound, and the tongue volume were calculated. Laryngoscope exposure and tracheal intubation were performed after anesthesia. The receiver operating characteristic (ROC) curve and the Youden''s index were used to obtain the critical value of each index to predict the difficult laryngoscopy.
Results Among 287 children, 13 children (4.53%) experienced difficult laryngoscopy. The statistical results showed that the following indicators were significantly related to the difficult laryngoscopy in children of different ages: the modified Mallampati score in children from 5 to 12 years old, the inter-incisor distance in children from 5 to 8 years old, the thyromental distance in children from 9 to 12 years old, the length of geniohyoid muscle in children from 5 to 12 years old,and the distance from skin to epiglottis in children from 5 to 8 years old. The AUC of the above indicators for predicting difficult laryngoscopy were between 0.7 and 0.9.
Conclusion The length of the geniohyoid muscle and the distance from skin to epiglottis measured under ultrasound may be both valuable indicators of difficult airway assessment in children.