气道超声预测面罩通气困难

贵州医科大学   麻醉与心脏电生理课题组

翻译：李奕   编辑：马艳燕   审校：曹莹

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夏天的风是蓝色的温柔

背景：在择期手术或危重情况管理期间，意外的困难气道可能危及生命。然而，由于现有临床测试的敏感性差，目前预测面罩通气困难仍然是一个挑战。我们的主要目标是验证术前上呼吸道超声测量是否有助于预测面罩通气困难。我们的次要目标是评估难以通气的患者和不通气的患者之间的临床特征和差异。 

方法：我们进行了一项前瞻性观察研究，招募了 250 名在 2017 年 9 月至 2018 年 10 月期间选择接受结直肠、胃、减肥和胰腺择期手术的成年患者。我们按照美国标准化方案对气道进行了术前评估。测量舌骨间距(DIM)、舌根厚度(SBL)、舌骨前软组织厚度(STTi)、甲状舌骨距离(DTI)、会厌前软组织厚度(STTe)、杓状软骨厚度(STTa)和声带联合厚度(STTcv)。

结果：SBL 高于 50 mm，对于曲线型和非曲线型患者的面罩通气困难具有预测作用。头部过伸和下颌半脱位 (DIMs) 的舌骨间距对曲线型患者有预测作用(保护性参数)。

无尽夏

Endless Summer

结论：气道超声评估可能是预测困难面罩通气的重要工具。需要进一步的研究验证所发现的参数，并将其与术前临床评估相结合。

原始文献来源：Amedeo Bianchini, Ludovica Nardozi, Elena Nardi, et al. Airways ultrasound in predicting difficult face mask ventilation.[J]. Minerva Anestesiol. 2021 Jan;87(1):26-34.

Airways ultrasound in predicting difficult face mask ventilation

Background: Unanticipated difficult airway is a potentially life-threatening event during elective surgery or management of critical conditions. Nevertheless, predicting difficult mask ventilation currently remains a challenge due to the poor sensitivity of available clinical tests. Our primary goal was to verify whether preoperative upper airway ultrasound measurements were useful to predict difficult face mask ventilation. Our secondary goal was to evaluate clinical characteristics and differences between patients who are difficult to ventilate and patients who are not. 

Method: We performed a prospective observational study, enrolling 250 adult patients selected for colorectal, gastric, bariatric and pancreatic elective surgery between September 2017 and October 2018. We performed a preoperative US assessment of the airways, following a standardized protocol. We measured the hyomental distance (DIM), the thickness of the base of the tongue (SBL), the thickness of the soft tissues anterior to the hyoid bone (STTi), thyro-hyoid distance (DTI), the thickness of soft tissue anterior to the epiglottis (STTe), to the arytenoid (STTa) and to the commissure of the vocal cords (STTcv). 

Results: SBL had a predictive role of difficult mask ventilation in curarized and noncurarized patients for values higher than 50 mm. Hyomental distance with hyperextension of the head and subluxation of the mandible (DIMs) had a predictive role in the curarized patient (protective parameter). 

Conclusion: Airways ultrasound evaluation could be an important tool to predict difficult mask ventilation. Further studies are necessary to validate the parameters found and correlate them to the preoperative clinical evaluation.