超声测量评估阻塞性睡眠呼吸暂停低通气综合征患者困难气道的价值

目的探究超声测量正中位舌骨到皮肤距离、声带水平前联合到皮肤的距离以及颏舌骨肌长度对于阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者困难气道预测的可行性。方法择期行全麻气管插管改良腭咽成形术的OSAHS患者37例,男32例,女5例,年龄20~69岁,ASAⅠ-Ⅲ级。术前评估改良Mallampati气道分级,超声测量正中位舌骨到皮肤距离、声带水平前联合到皮肤距离以及颏舌骨肌长度。根据Cormack-Lehane分级法评定普通喉镜暴露程度(Ⅲ、Ⅳ级为困难气道),采用ROC曲线分析各指标预测困难气道的效能。结果 37例患者中11例纳入困难气道组,26例纳入非困难气道组。困难气道组声带水平前联合到皮肤距离明显长于非困难气道组(P<0.05),而颏舌骨肌长度明显短于非困难气道组(P<0.05)。两组正中位舌骨刮皮肤距离差异无统计学意义。改良Mallampati气道分级、声带水平前联合到皮肤距离及颏舌骨肌长度预测困难气道的AUC及其95%CI分别为0.788(0.640~0.937)、0.804(0.643~0.966)和0.788(0.642~0.935),三者联合的AUC及其95%CI为0.955(0.895~1.000),敏感性100%,特异性84.6%。结论超声测量声带水平前联合到皮肤距离及颏舌骨肌长度对于OSAHS患者困难插管有一定的预测价值,且综合三种预测方法,可提高预测的准确性。

Evaluation of difficult airway in patients with obstructive sleep apnea hypopnea syndrome by ultrasonography

Objective To explore the feasibility of difficult airway prediction in the patients suffering from obstructive sleep apnea hypopnea syndrome(OSAHS) by ultrasonometry measuring the distance from the hyoid bone to the skin in median cephalic position,the distance from the anterior syndesmosis of vocal cord to the skin,and the length of genioglossal muscle. Methods Thirty-seven cases of OSAHS patients, 32 males and 5 females, aged 20-69 years, falling into ASA physical status Ⅰ-Ⅲ category undergoing endotracheal intubation and general anesthesia for modified palatopharyngoplasty were enrolled.Before the operation, modified Mallampati airway classification was evaluated. The distance from the hyoid bone to the skin in the median position, the distance from the anterior syndesmosis of vocal cord to the skin and the length of the genioglossal muscle were measured by ultrasound. All the patients were divided into two groups according to Cormack-Lehane grading method. The value of each index in airway evaluation of OSAHS patients was analyzed. Results A total of 37 cases were included, 11 cases were divided into difficult airway group and 26 cases in non-difficult airway group. The distance from anterior union to skin was longer in the difficult laryngoscope group than the non-difficult laryngoscope group(P < 0.05). The length of genioglossal muscle was shorter in the difficult larygoscope group than in the non-difficult larygoscope group(P < 0.05). There was no significant difference in the distance from the hyoid bone to the skin in the median position between the two groups. The area under ROC curve of the modified Mallampati airway classification, the distance from the anterior syndesmosis of vocal cord to the skin and the length of genioglossal muscle was 0.788(95%CI 0.640-0.937), 0.804(95%CI 0.643-0.966), and 0.788(95%CI 0.642-0.935), respectively. The area under ROC curve of integrated three measurements was 0.955(95%CI 0.895-1.000). Conclusion Ultrasonic measurement of the distance from the anterior syndesmosis of vocal cord to the skin and the length of genioglossal muscle can predict the difficult intubation of OSAHS patients. Moreover, the accuracy of predicting difficult endotracheal intubation in patients with obstructive sleep apnea hypopnea syndrome can be improved by the combination of three prediction methods.