超声测量下颌骨髁状突活动度预测困难气道

发布时间：2018-01-24 06:58

  本文关键词： 超声 颞下颏关节活动度 全身麻醉 气管插管 困难气道　出处：《皖南医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的:运用超声测量下颌骨髁状突的活动度是一种新型、可靠的评估颞下颏关节(temporomandibular joint,TMJ)活动度的方法。然而,与其他相关预测困难气道的方法相比,运用超声测量出的下颌骨髁状突的活动度受限是否可以准确地预测困难气道,尤其是喉镜显露困难,还不得而知。本研究就是为了观察运用超声测量下颌骨髁状突的活动度预测喉镜显露困难的能力。方法:选择拟在全身麻醉气管插管下行择期手术的成年患者600例,排除颌面部创伤、无牙、不能完全配合的患者。运用超声测量所有纳入标准患者的髁状突的移动距离来评估其下颌骨髁状突的活动度。同时于全身麻醉前测量其他反映颞下颏关节活动度的预测指标,如张口度、下门齿前伸距离、咬上嘴唇分级。诱导后行气管插管,观察每个纳入标准患者的喉镜显露分级(Cormack-Lehane level)。结果:本研究共纳入536例患者,其中,喉镜显露困难者(Cormack-Lehane level2)47例。运用Youden指数确立的超声测量髁状突活动度预测困难喉镜显露的最佳预测标准是髁状突的移动距离≤10mm。在以上所有的这些预测标准中,髁状突的移动距离与喉镜显露分级之间具有最高的相关性(r=-0.467,P0.001),与喉镜显露困难的受试者工作特征(receiver operating characteristic curve,ROC)曲线下的面积最大(0.958)。同时,配对卡方检验与一致性测试显示:髁状突移动距离≤10mm与困难喉镜显露之间具有最高的kappa值(Kappa=0.687,95%CI:0.586-0.788)。在OR值方面,髁状突活动受限具有最高的预测价值:OR值为122(95%CI:47-313),敏感度为0.872(95%CI:0.743-0.952),特异度为0.947(95%CI:0.923-0.965),阳性预测值为0.612(95%CI:0.484-0.725),阴性预测值为0.987(95%CI:0.972-0.995)。结论:运用超声测得的下颌骨髁状突活动度可以有效地预测困难喉镜显露,且具有较高的预测价值。
[Abstract]:Objective: to measure the motion of mandibular condyle by ultrasound is a new and reliable method to evaluate temporomandibular joint of mandibular condyle. However, compared with other relevant methods for predicting difficult airway, whether the condylar movement of the mandibular condyle measured by ultrasound can accurately predict the difficult airway. In particular, laryngoscope is difficult to expose. The purpose of this study was to observe the ability of ultrasound to measure the movement of the mandibular condyle to predict the difficulty of laryngoscope exposure. 600 adult patients undergoing elective surgery under general anesthesia and tracheal intubation were selected. Excluded maxillofacial trauma, edentulous. Measure the movement distance of condyle of all the standard patients by using ultrasound to evaluate the movement of mandibular condyle. Also measure other movements of the temporomandial joint before general anesthesia. To predict. Such as mouth opening, lower incisor forward extension distance, bite lip grading. After induction endotracheal intubation. Results: 536 patients were included in this study. Laryngoscope exposure difficulty: Cormack-Lehane level 2). 47 cases. The best predictor of difficult laryngoscope exposure using Youden index is the movement distance of condyle 鈮，

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