超声在鉴别颈部标志物不明显的受试者的环甲膜方面优于触诊：一项随机临床试验
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Ultrasound Is Superior to Palpation in Identifying the Cricothyroid Membrane in Subjects with Poorly Defined Neck Landmarks：A Randomized Clinical Trial
背景与目的
环甲切除术的成功与否取决于能否准确识别环甲膜。本研究的目的是比较超声与外部触诊在环甲膜定位中的准确性。
方 法
对在加拿大多伦多大学卫生网络医院的223例颈部解剖异常患者进行颈部计算机断层扫描，随机分为两组:外触诊组和超声组。将超声或外触诊确定的环甲膜定位点与一名对分组分配不了解的放射科医生得出的环甲膜参考中点(计算机断层扫描点)进行比较。主要指标是环状甲膜识别的准确性，用数字尺以毫米为单位测量从计算机环甲膜扫描点到超声点或外触诊点的距离。环甲膜定位成功是以从计算断层扫描点到超声点或外触诊点的距离为5毫米范围内的精确次数。
结 果
超声定位的准确率是外触诊组的10倍(81%对8%);95% CI, 63.6 - 81.3%;P < 0.0001)。从外触诊点到计算断层扫描点的平均距离(SD)是超声定位点到计算断层扫描点距离的5倍(16.6 7.5 mm vs. 3.4 3.3 mm);95% CI, 11.67到14.70;P < 0.0001)。分析表明，外触诊环甲膜定位不准确的风险比超声大9.14倍(P < 0.0001)。无不良反应发生。
结 论
在颈部标志物不明确的受试者中，超声定位环甲膜的准确性高于外触诊。
原始文献摘要
Siddiqui N, Yu E, Boulis S, et al. Ultrasound Is Superior to Palpation in Identifying the Cricothyroid Membrane in Subjects with Poorly Defined Neck LandmarksA Randomized Clinical Trial[J]. Anesthesiology: The Journal of the American Society of Anesthesiologists, 2018, 129(6): 1132-1139.
Background: Success of a cricothyrotomy is dependent on accurate identification of the cricothyroid membrane. The objective of this study was to compare the accuracy of ultrasonography versus external palpation in localizing the cricothyroid membrane.
Methods: In total, 223 subjects with abnormal neck anatomy who were scheduled for neck computed-tomography scan at University Health Network hospitals in Toronto, Canada, were randomized into two groups: external palpation and ultrasound. The localization points of the cricothyroid membrane determined by ultrasonography or external palpation were compared to the reference midpoint (computed-tomography point) of the cricothyroid membrane by a radiologist who was blinded to group allocation. Primary outcome was the accuracy in identification of the cricothyroid membrane, which was measured by digital ruler in millimeters from the computed-tomography point to the ultrasound point or external-palpation point. Success was defined as the proportion of accurate attempts within a 5-mm distance from the computed-tomography point to the ultrasound point or external-palpation point.
Results: The percentage of accurate attempts was 10-fold greater in the ultrasound than external-palpation group (81% vs. 8%; 95% CI, 63.6 to 81.3%; P < 0.0001). The mean (SD) distance measured from the external-palpation to computed-tomography point was five-fold greater than the ultrasound to the computed-tomography point (16.6 7.5 vs. 3.4 3.3 mm; 95% CI, 11.67 to 14.70; P < 0.0001). Analysis demonstrated that the risk ratio of inaccurate localization of the cricothyroid membrane was 9.14-fold greater with the external palpation than with the ultrasound (P < 0.0001). There were no adverse events observed.
Conclusions: In subjects with poorly defined neck landmarks, ultrasonography is more accurate than external palpation in localizing the cricothyroid membrane.
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贵州医科大学高鸿教授课题组
编辑：李华宇 审校：代东君