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【经典文献阅读】气道超声作为直接喉镜检查困难的预测因素:系统回顾和荟萃分析
 

Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis

气道超声作为直接喉镜检查困难的预测因素系统回顾和荟萃分析



BACKGROUND: Despite several clinical index tests that are currently applied for airway assessment, unpredicted difficult laryngoscopy may still represent a serious problem in anesthesia practice. The aim of this systematic review and meta-analysis was to evaluate whether preoperative airway ultrasound can predict difficult direct laryngoscopy in adult patients undergoing elective surgery under general anesthesia.

背景尽管目前有几个临床指标测试被应用于气道评估,但无法预测的困难喉镜检查可能仍然是麻醉实践中的一个严重问题。本系统综述和荟萃分析的目的是评估在全麻下接受择期手术的成人患者,术前气道超声是否能预测困难的直接喉镜检查。


METHODS: We searched the Medline, Scopus, and Web of Science databases from their inception to December 2020. The population of interest included adults who required tracheal intubation for elective surgery under general anesthesia without clear anatomical abnormalities suggesting difficult laryngoscopy. A bivariate model has been used to assess the accuracy of each ultrasound index test to predict difficult direct laryngoscopy.

方法:我们在MedlineScopusWeb of Science数据库中检索了从最初202012月的数据。所关注的人群包括全麻下需要气管插管进行择期手术的成人,他们没有明确的解剖异常提示困难喉镜检查。一个双变量模型已经被用来评估每个超声指数测试预测困难直接喉镜检查的准确性。


RESULTS: Fifteen studies have been considered for quantitative analysis of summary receiver operating characteristic (SROC). The sensitivity for distance from skin to epiglottis (DSE), distance from skin to hyoid bone (DSHB), and distance from skin to vocal cords (DSVC) was 0.82 (0.74–0.87), 0.71 (0.58–0.82), and 0.75 (0.62–0.84), respectively. The specificity for DSE, DSHB, and DSVC was 0.79 (0.70–0.87), 0.71 (0.57–0.82), and 0.72 (0.45–0.89), respectively. The area under the curve (AUC) for DSE, DSHB, DSVC, and ratio between the depth of the pre-epiglottic space and the distance from the epiglottis to the vocal cords (Pre-E/E-VC) was 0.87 (0.84–0.90), 0.77 (0.73–0.81), 0.78 (0.74–0.81), and 0.71 (0.67–0.75), respectively. Patients with difficult direct laryngoscopy have higher DSE, DSVC, and DSHB values than patients with easy laryngoscopy, with a mean difference of 0.38 cm (95% confidence interval [CI], 0.17–0.58 cm; P = .0004), 0.18 cm (95% CI, 0.01–0.35 cm; P = .04), and 0.23 cm (95% CI, 0.08–0.39 cm; P = .004), respectively.

结果:有15项研究被考虑用于总结接收者操作特征(SROC)的定量分析。皮肤到会厌的距离(DSE)、皮肤到舌骨的距离(DSHB)和皮肤到声带的距离(DSVC)的敏感性分别为0.820.74-0.87)、0.710.58-0.82)和0.750.62-0.84)。DSEDSHBDSVC的特异性分别为0.790.70-0.87)、0.710.57-0.82)和0.720.45-0.89)。DSEDSHBDSVC曲线下面积(AUC)、会厌前间隙深度与会厌至声带距离的比值(Pre-E/E-VC)分别为0.87(0.84-0.90)0.77(0.73-0.81)0.78(0.74-0.81)0.71(0.67-0.75)。困难直接喉镜患者的DSEDSVCDSHB值高于容易喉镜患者,平均差异0.38 cm(95%置信区间[CI]0.17-0.58 cm;P = .0004)0.18 cm (95% CI, 0.01-0.35 cm;P = .04)0.23 cm (95% CI, 0.08-0.39 cm;P = .004)


CONCLUSIONS: Our study demonstrates that airway ultrasound index tests are significantly different between patients with easy versus difficult direct laryngoscopy, and the DSE is the most studied index test in literature to predict difficult direct laryngoscopy. However, it is not currently possible to reach a definitive conclusion. Further studies are needed with better standardization of ultrasound assessment to limit all possible sources of heterogeneity.

结论:我们的研究表明,气道超声指标测试在容易和困难的直接喉镜患者之间有显著差异,DSE是文献中研究最多的预测直接喉镜困难的指标测试。然而,目前还不可能得出一个明确的结论。需要进一步的研究,超声评估进行更好的标准化,以限制所有可能的异质性来源。

KEY POINTS

· Question: Is preoperative upper airway ultrasound able to predict a difficult airway in adult patients undergoing elective surgery under general anesthesia without clear anatomical abnormalities suggesting difficult laryngoscopy?

· Findings: The distance from skin to epiglottis was the most extensively assessed index test in literature and seems accurate to predict difficult laryngoscopy.

· Meaning: The high heterogeneity performing ultrasound and the limited number of studies do not allow to reach a definitive conclusion, and the routine use of ultrasound to predict difficult laryngoscopy cannot still be recommended.

关键点

问题对无明显解剖异常提示喉镜检查困难的成人患者,术前上气道超声能否预测在全麻择期手术的困难气道?

结果从皮肤到会厌的距离是文献中评估最广泛的指标测试,似乎可以准确预测困难喉镜检查。

意义超声检查的高度异质性和有限的研究数量不允许得出明确的结论,因此仍不能推荐常规使用超声来预测困难喉镜检查。

文/苏洋

排版/肉肉

Airway Ultrasound as Predictor of Difficult Direct .pdf

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