如何預(yù)測(cè)困難氣管插管資料講解

如何預(yù)測(cè)困難氣管插管?

HowtoPredictDifficultIntubation四川大學(xué)華西醫(yī)院麻醉科TroublewithAirwayDefinitionTeststodeterminedifficultintubationareforlaryngoscopyandmaynotapplytoalldevicesDifficultintubationvsDifficultlaryngoscopyMaynotseecordsyetbeabletointubationMayseecordsandnotbeabletointubationCormack&Lehane喉鏡暴露分級(jí)

LEMON

法則

Lookexternally.

Evaluatethe3-3-2rule.

Mallampati.

Obstruction?

Neckmobility.LookExternally

（外觀檢查）肥胖（Obesity）頸短粗（Shortbullneck）高腭弓（Higharchingpalate）上門(mén)牙突出（ProminentUpperIncisors，BuckTeeth）小下頜（Recedingmandible，Dentures）無(wú)牙（Edentulousmouth）面部畸形（Abnormalfacialshape）面部創(chuàng)傷（Facialtrauma）Evaluatethe3-3-2rule

（3-3-2法則）3fingersbetweenthepatient’steeth(patient’smouthshouldopenadequatelytopermitthreefingerstobeplacedbetweentheupperandlowerteeth)3fingersbetweenthetipofthejawandthebeginningoftheneck(underthechin)2fingersbetweenthethyroidnotchandthefloorofthemandible(topoftheneck)改良Mallampati分級(jí)Obstruction?

（是否存在梗阻因素）腫瘤膿腫血腫會(huì)厭炎甲狀腺腫大NeckMobility

（頸椎活動(dòng)度）氣道評(píng)估指標(biāo)Anesthesiology2003;98:1269-77.WilsonIndex（Wilson指數(shù)）BrJAnaesth1988;61:211-6.兩個(gè)距離指標(biāo)甲-頦距離﹤6cm胸-甲距離﹤12.5cm困難氣管插管的解剖機(jī)制EurJAnaesthesiol2001;18:3-12.如何評(píng)估困難氣管插管預(yù)測(cè)指標(biāo)UpperLipBiteTest（咬上嘴唇試驗(yàn)）A,ClassI;lowerincisorsreflectingabiteoftheupperlip,makingitsmucosaentirelyinvisible.B,ClassII;lowerincisorshalf-bitingtheupperlip,makingthemucosapartiallyinvisible.C,ClassIII;lowerincisorsattemptingabitebuttotallyfailingtocatchtheupperlip.AnesthAnalg2003;96:595-9.AnesthAnalg2003;96:595-9.Theupperlipbitetestisanacceptableoptionforpredictingdifficultintubationasasimple,singletest.AnesthAnalg2005;101:284-9.Bothtestsarepoorpredictorsassinglescreeningtests.ThespecificityandaccuracyoftheULBTissignificantlyhigherthantheothertestsandismoreaccurateinairwayassessment.However,theULBTinconjunctionwiththeothertestscouldmorereliablypredicteasylaryngoscopyorintubation.Comparisonoftwomethodsforpredictingdifficultintubationinobstetricpatients

ComparingmodifiedMallampatitestwithWilsonrisksumscorein372obstetricpatientsMallampaticlassIIIorIVpredicted15ofthe23patientswhileWilsonrisksumscore>or=2predicted9ofthe14patientsinwhomtrachealintubationwasdifficult.MiddleEastJAnesthesiol.2003Jun;17(2):275-85.TestSensitivity(%)Specificity(%)Positivepredictivevalue(%)Mallampatiscore6097.665(gradeIIIorIV)Wilsonrisksumscore(≥2)3698.564Combinationoftwotests10096.264.8ProtrusionoftheMandible（下頜前突）PredictivevalueforMallampatiscore,thyromentaldistance,sternomentaldistanceandprotrusionofthemandibleaspredictorsofdifficultintubationBrJAnaesth1994;73:149-53.

TestSensitivity(%)Specificity(%)Positivepredictivevalue(%)Mallampatiscore64.766.18.9(gradeIIIorIV)(38.3-85.6)(61.0-71.2)(3.9-13.9)Thyromentaldistance64.781.415.1

(≤6.5cm)(38.3-85.6)(77.2-85.6)(7.8-25.4)Sternomentaldistance

82.488.626.9

(≤12.5cm)(56.6-96.2)(85.2-92.0)(15.6-41.0)Protrusionofmandible29.485.09.1

(positionBorC)(10.3-56.0)(81.2-88.8)(3.0-20.0)

CanJAnesth2005;52(3):291–296.Forty-twostudiesenrolling34,513patientswereincluded.

Forpredictingdifficultlaryngoscopy,bothversionsoftheMallampatitesthadgoodaccuracy.Forpredictingdifficultintubation,themodifiedMallampatitesthadgoodaccuracy.Usedalone,theMallampatitestshavelimitedaccuracyforpredictingthedifficultairwayandthusarenotusefulscreeningtests.AnesthAnalg.2006;102(6):1867-78.Thirty-fivestudies