术前经鼻内窥镜检查预测困难气道的作用:前瞻性队列研究
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Pre-operative transnasal endoscopy as a predictor of difficult airway
背景与目的
气管插管失败的后果严重，因此预测困难气道十分重要。目前关于预测困难气道的最佳方式尚无统一结论，因此本研究评价经鼻内窥喉镜(TFEL)在预测插管困难中的作用。
方 法
共169名使用TFEL在全麻下择期行耳鼻喉手术的成年患者纳入研究。除由麻醉医生进行常规术前评估外，TFEL的声门暴露用改良的Cormack-Lehane评分系统(MCL)进行评估。TFEL提高困难气道预测能力用MCL评分衡量；对困难插管预测效果用插管难度量表评分衡量。
结 果
在床边评估时，舌突出时进行的TFEL显著改善了MCL的预测效果(P=0.005)。受试者工作特征曲线下面积为0.75[95%CI：0.67-0.83]vs.0.65(95%CI：0.58-0.74)。插管难度评分(P=0.049)，受试者工作特征曲线下面积为0.70(95%CI 0.61-0.80）vs0.66(95%CI：0.58-0.74)。
结 论
TFEL是预测困难插管的有效工具，提高了常规床旁评估的可预测性。
原始文献摘要
Marco G, Luca B, Davide DS,et,al.Pre-operative transnasal endoscopy as a predictor of difficult airway.[J]Eur J Anaesthesiol 2020; 37:98–104 DOI:10.1097/EJA.0000000000001127
BACKGROUND Consequences of failed endotracheal intubation can be catastrophic and predicting difficulty is thereforeacriticalissue. There is no consensus on the best way to predict difficulty.
OBJECTIVE To evaluate the role of transnasal flexible endoscopic laryngoscopy (TFEL), a minimally invasive procedure, in the prediction of difficult intubation.
DESIGN Prospective cohort study.
SETTING San Raffaele Hospital, Milan, a tertiary university hospital.
PATIENTS One hundred and sixty nine adults scheduled for elective ear, nose and throat surgery under general anaesthesia with pre-operative TFEL.
INTERVENTION In addition to routine pre-operative evaluation by an anaesthesiologist, glottis exposure during TFEL was assessed with a scoring system similar to the modified Cormack–Lehane (MCL).
MAIN OUTCOME MEASURES The extent to which TFEL improves the prediction of difficult direct laryngoscopy, measured with the MCL score, and of difficult intubation, measured with the intubation difficulty scale score.
RESULTS When added to bedside evaluation, TFEL performed during tongue protrusion significantly (P¼0.005) improved the prediction of MCL. The area under the receiver operating characteristics curve was 0.75 [95% confidenceinterval(CI)0.67to0.83]vs.0.65(95%CI0.58to0.74).For the intubation difficulty scale (P¼0.049), the area under the receiver operating characteristics curve was 0.70 (95% CI 0.61 to 0.80) vs. 0.66 (95% CI 0.58 to 0.74).
CONCLUSION TFEL is a useful tool in predicting difficult intubation, improving predictability of routine bedside evaluation.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙