上唇咬诊试验预测肥胖患者困难气管插管的应用价值研究

目的：观察上唇咬诊试验（Upper Lip Bite Test,ULBT）预测肥胖患者困难气管插管的临床应用价值。方法：气管内全麻下行择期外科手术的肥胖患者[体重指数（body mass index,BMI）大于30 kg/m2]200例,参与本研究的麻醉医生分为三组,M组负责术前评估患者的改良的Mallampati分级,U组负责术前评估患者ULBT分级,C组负责评估患者喉镜暴露声门时的Cormack and Lehane分级。改良的Mallampati、Cormack and Lehane、ULBT三类分级中Ⅰ、Ⅱ级视为非困难插管,Ⅲ、Ⅳ级视为困难插管。记录M、U组预测试验的灵敏度、特异性、阳性预测值、阴性预测值和精确度,并进行统计学分析。结果：我们对200例围手术期肥胖患者进行了观测,126例患者改良的Mallampati分级Ⅰ、Ⅱ级,74例Ⅲ、Ⅳ级。177例患者ULBT分级Ⅰ、Ⅱ级,23例Ⅲ级。ULBT在特异性、精确度、阳性预测值三方面均优于改良的Mallampati分级（P〈0.05）。灵敏度、阴性预测值两组差异无统计学意义（P〉0.05）。结论：ULBT用于肥胖患者围手术期气道评估,方法简单、有效,有一定的临床应用价值。

Applicational Value of The Upper Lip Bite Test for Predicting Difficult Tracheal Intubation in Obstetric Patients

Objective： To observe the clinical applicational value of the upper hp bite test（ULBT ）tor predicting difficult tracheal intubation in obstetric patients. Methods： 200 obstetric patients with BMI more than 30 kg/m2 undergoing operation were enrolled. The anesthetist in this study were divided into three groups：group M to evaluate preoperative modified Mallampati grading, group U to evaluate preoperative ULBT grading, and group C to evaluate Cormack and Lehane grading when exposing glottis by laryngoscope. In modified Mallampati grading and ULBT grading and Cormack and Lehane grading, the grade Ⅰ andⅡ were considered as easy intubation, grade Ⅲ and Ⅳas difficult intubation. The sensitivity , specificity, positively predictive values , negatively predictive values and accuracy in both groups were recorded and statistically analyzed. Results：Of 200 cases, 126 cases was in gradeⅠ and Ⅱ and 74 in grade Ⅲ and Ⅳ by modified Mallampati grading; 177 cases was in grade Ⅰ and Ⅱand 23 in grade Ⅲ by ULBT grading. ULBT is superior to modified Mallampati grading in specificity, accuracy and positively predictive values（ P 〈 0.05）. There was no difference in sensitivity and negatively predictive values（P 〉 0.05）. Conclusion： ULBT is simple and effective in evaluating the tracheal aspiration in perioperative obstetric patients.