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Received:September 22, 2020 Published Online:December 20, 2020
Received:September 22, 2020 Published Online:December 20, 2020
中文摘要: 目的 探讨超声测量不同头位下舌颏距离(HMD)、舌骨至皮肤的距离(DSHB)、声带前联合至皮肤的距离(DSAC)以及会厌至皮肤的距离(DSEM)对于行脑深部刺激器植入术的患者困难面罩通气(DMV)预测的可行性。方法 选择2015年1月至2020年8月气管插管全身麻醉下行择期脑深部刺激器植入术的患者37例进行前瞻性观察性临床研究，其中男性10例，女性27例，年龄34~74岁，ASA分级Ⅱ~Ⅳ级。术前未佩戴立体定位头架时评估甲颏间距与改良Mallampati气道分级，应用床旁超声测量仰卧正中位与最大后仰位的HMD并计算舌颏距离率，同时测量仰卧正中位的DSHB、DSAC以及DSEM；佩戴立体定位头架后再次应用超声测量上述指标。根据面罩通气评分评定诱导后面罩通气困难程度，采用ROC曲线分析各指标预测DMV的效能，采用Youden指数确定预测DMV的最佳值，以此标准计算各指标预测DMV的灵敏性和特异性。结果 37例患者中4例纳入DMV组，33例纳入非DMV组。DMV组佩戴头架后的HMD显著短于非DMV组(P<0.05)，DSHB显著长于非DMV组(P<0.05)。佩戴头架后的HMD、DSHB预测DMV的AUC及其95%CI分别为0.83(0.672~0.988)与0.81(0.617~0.997)，最佳截点分别为4.12 cm与1.02 cm，敏感性分别为100.00%与75.00%，特异性分别为66.67%与66.67%。结论 超声测量HMD与DSHB对于佩戴立体定位头架的脑深部刺激器植入术患者DMV具有较高的预测价值。
Abstract:Objective To investigate the feasibility of airway ultrasound evaluation of the distance between the hyomental distance (HMD), distance from skin to the hyoid bone (DSHB), distance from skin to anterior commissure of the vocal cords (DSAC) and distance from skin to epiglottis midway (DSEM) in predicting difficult mask ventilation (DMV) in patients undergoing deep brain stimulator insertion (DBSI). Methods From January 2015 to August 2020, 37 patients received DBSI under tracheal intubation general anesthesia were selected for prospective observational clinical study, including 10 males and 27 females, aged 34-74 years, ASA grade Ⅱ-Ⅳ.Before the operation, the thyromental distance and modified Mallampati airway classification were evaluated when stereotactic head rest was not wearing.The HMD of supine median position and maximum supine position were measured by bedside ultrasound, and the lingual chin distance rate was calculated, meanwhile the DSHB, DSAC and DSEM of supine median position were measured before and after the stereotactic head rest was worn.According to the mask ventilation score, the difficulty degree of mask ventilation after induction was evaluated.ROC curve was used to analyze the effectiveness of each index in predicting DMV.Youden index was used to determine the best value for predicting DMV.The sensitivity and specificity of each index in predicting DMV were calculated based on this standard. Results Of the 37 patients, 4 were included in the DMV group and 33 in the non-DMV group.HMD of DMV group was significantly shorter than that of non-DMV group (P<0.05), and DSHB was significantly longer than that of non-DMV group (P<0.05).The AUC and 95%CIof HMD and DSHB in predicting DMV were 0.83 (0.672-0.988) and 0.81 (0.617-0.997), respectively.The best cut-off points were 4.12 cm and 1.02 cm, the sensitivity was 100.00% and 75.00%, and the specificity was 66.67% and 66.67%, respectively. Conclusion HMD and DSHB measured by ultrasound have high predictive value for DMV in patients with deep brain stimulator implantation wearing stereotactic head rest.
keywords: Difficult mask ventilation Airway ultrasound evaluation Ultrasound Stereotactic head rest Deep brain stimulator implantation Predictive efficacy
文章编号： 中图分类号：R614.2 文献标志码：A
基金项目:国家自然科学基金(81771142)；江苏省“六大人才高峰”选拔培养资助项目(YY-084)；江苏省科协青年科技人才托举工程资助项目(苏科协发［2018］202-1)
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