摘要
目的 探讨锥形束CT(CBCT)测量舌厚度(TT)在预测颌面外科手术患者声门暴露困难的有效性.方法 选择择期在全麻下行颌面手术患者 97 例,男 45 例,女 52 例,年龄 18～67 岁,ASA Ⅰ或Ⅱ级.术前采用 CBCT 测量 TT,并记录张口度(IID)、BMI、甲颏距离(TMD)、改良Mallampati分级(MMT).根据全麻诱导时Cormack-Lehane(CL)分级将患者分为两组:喉镜易显露组(E组,CL分级Ⅰ或Ⅱ级,n=86)和喉镜难显露组(D组,CL分级Ⅲ或Ⅳ级,n=11).分析IID、BMI、TMD、MMT、TT与喉镜暴露的关系,并采用受试者工作特征(ROC)曲线分析各项指标预测喉镜显露困难的有效性.结果 与E组比较,D组BMI、MMT Ⅲ、Ⅳ级占比明显升高(P＜0.05),TT明显延长(P＜0.05),TMD明显缩短(P＜0.05).BMI、TMD、MMT、TT预测喉镜暴露困难的ROC曲线下面积(AUC)分别为 0.690、0.714、0.726、0.797,敏感性分别为 36.4%、63.6%、63.6%、81.8%,特异性分别为 95.3%、69.8%、76.7%、68.6%.将 BMI、MMT、TMD、TT 作为模型预测喉镜暴露困难 AUC 为0.913,敏感性为 90.9%,特异性为 83.7%.结论 CBCT测量TT是预测喉镜暴露困难的独立影响因素,同时纳入BMI、TMD、MMT和TT四个指标的综合模型具有更好的预测效果.
Abstract
Objective To investigate the accuracy of cone-beam CT(CBCT)by measuring tongue thickness(TT)in predicting difficult glottis exposure in patients undergoing maxillofacial surgery.Methods Ninety-seven patients undergoing elective maxillofacial surgery under general anesthesia were selected,45 males and 52 females,aged 18-67 years,ASA physical status Ⅰ or Ⅱ.The TT was measured by CBCT before operation.The inter-incisor distance(IID),BMI,thyromental distance(TMD),and modified Mal-lampati test(MMT)were also recorded.According to the Cormack-Lehane(CL)grade at the time of gener-al anesthesia induction,the patients were divided into two groups:the easy laryngoscope exposure group(group E,CL gradeⅠorⅡ,n = 86)and the difficult laryngoscope exposure group(group D,CL gradeⅢ or Ⅳ,n = 11).The relationship between IID,BMI,TMD,MMT,TT,and laryngoscopy exposure was analyzed,and the receiver operating characteristic(ROC)curve was used to analyze the relationship be-tween each index and difficult laryngoscopy exposure.Results Compared with group E,the BMI,MMT,and TT of group D were significantly increased(P＜0.05),while the TMD was significantly decreased(P＜0.05).The area under the ROC curve(AUC)of BMI,TMD,MMT,and TT to predict difficult glot-tis exposure was 0.690,0.714,0.726,and 0.797,the sensitivity was 36.4%,63.6%,63.6%,and 81.8%,and the specificity was 95.3%,69.8%,76.7%,and 68.6%,respectively.Using BMI,MMT,TMD,and TT as a model to predict difficult glottis exposure,the AUC was 0.913,the sensitivity was 90.9%and the specificity was 83.7%.Conclusion TT measured by CBCT is an independent impact factor for predicting difficult laryngoscope exposure.The comprehensive model incorporating BMI,TMD,MMT,and TT has a better predictive effect.
基金项目
南通市社会民生科技计划-面上项目(MS22022079)
NETL
NSTL
维普
万方数据