基于arne的新预测体系评估困难气道的研究-第三军医大学学报.docVIP

基于Arne的新预测体系评估困难气道的研究 靳皓，陈萍* （重庆医科大学附属第一医院麻醉科，重庆 400016）( 摘要：目的：根据Arne气道评估体系建立一种较为准确的新预测系统。方法：选择113例全麻后插管困难的患者(病例组)，按年龄与性别1：1配对，选择全麻后喉镜暴露正常患者113例(对照组)，分别记录有无困难插管史、困难插管相关疾病、气道疾病等病史，记录张口度、颞颌关节活动度、身高、甲颏距离、头颈活动度、Mallampati分级等指标的数值。以条件Logistic回归拟合Cox模型剔除非相关因素，筛选出相关危险因素建立新预测体系，并分别用新系统和Arne评估气道。结果：①Arne系统的8项指标中经条件Logistic回归分析得出有5项为相关危险因素，其相对危险度估计值(OR)及95％可信区间(95％CI)按OR由大到小依次为: 气道疾病（19.57，1.28～94.33），Mallampati分级（15.39,1.14～87.74），身高甲颏距离比（11.62,1.06～75.41），困难插管史（5.45,0.97～46.23），张口度（2.78,0.91～12.50）②新预测体系灵敏度、特异性、阳性预测值、阴性预测值分别为85.8%、70.8%、74.6%和83.3%。结论：新预测系统可较准确地评估困难气道。 关键词：困难插管；Arne；身高甲颏距离比； 中图分类号:R614.2 文章标识码：A The study of a new system for predicting difficult airway based on Arne system JINHao，CHENPing*Abstract:Objective: A new system based on Arne system was set up for predicting difficult laryngoscopy.Methods:113 patients who suffered from difficult laryngoscopy consisted the case group.According to principles of the same sex,similar age,113 patients with easy laryngoscopy were paired with the case group.Airway characteristics such as knowledge by the patient of previous difficult laryngoscopy,pathologies associated with difficult laryngoscopy,clinical symptoms of airway pathology,height,thyromental distance(TMD),maximum range of the head and neck movement,inter-incisor gap and mandible luxation were recorded.Logistic regression analysis was applied to find a new system. Arne system and new system was applied respectively.Results: ①Risk factors of difficult laryngoscopy were clinical symptoms of airway pathology, Mallampati test,ratio of height and TMD, knowledge of difficult laryngoscopy and inter-incisor gap.The odd radios were（19.57，1.28～94.33），（15.39,1.14～87.74），（11.62,1.06～75.41），（5.45,0.97～46.23），（2.78,0.91～12.50）.②The new system got the sensitivity,specificity,positive predictive value and the negative predictive value of 85.8,70.8,74.6 and 83.3 respectively.Conclusion:The new system could predict difficult airway appropriately. Key words:difficult laryngoscopy