如何预测困难气管插管.ppt

如何预测困难气管插管?HowtoPredictDifficultIntubation,四川大学华西医院麻醉科,TroublewithAirwayDefinition,TeststodeterminedifficultintubationareforlaryngoscopyandmaynotapplytoalldevicesDifficultintubationvsDifficultlaryngoscopyMaynotseecordsyetbeabletointubationMayseecordsandnotbeabletointubation,Cormack98:1269-77.,WilsonIndex（Wilson指数）,BrJAnaesth1988;61:211-6.,两个距离指标,甲-颏距离6cm胸-甲距离12.5cm,困难气管插管的解剖机制,EurJAnaesthesiol2019;18:3-12.,如何评估困难气管插管预测指标,UpperLipBiteTest（咬上嘴唇试验）,A,ClassI;lowerincisorsreflectingabiteoftheupperlip,makingitsmucosaentirelyinvisible.B,ClassII;lowerincisorshalf-bitingtheupperlip,makingthemucosapartiallyinvisible.C,ClassIII;lowerincisorsattemptingabitebuttotallyfailingtocatchtheupperlip.,AnesthAnalg2019;96:595-9.,AnesthAnalg2019;96:595-9.,Theupperlipbitetestisanacceptableoptionforpredictingdifficultintubationasasimple,singletest.,AnesthAnalg2019;101:284-9.,Bothtestsarepoorpredictorsassinglescreeningtests.,ThespecificityandaccuracyoftheULBTissignificantlyhigherthantheothertestsandismoreaccurateinairwayassessment.However,theULBTinconjunctionwiththeothertestscouldmorereliablypredicteasylaryngoscopyorintubation.,Comparisonoftwomethodsforpredictingdifficultintubationinobstetricpatients,ComparingmodifiedMallampatitestwithWilsonrisksumscorein372obstetricpatientsMallampaticlassIIIorIVpredicted15ofthe23patientswhileWilsonrisksumscoreor=2predicted9ofthe14patientsinwhomtrachealintubationwasdifficult.,MiddleEastJAnesthesiol.2019Jun;17(2):275-85.,ProtrusionoftheMandible（下颌前突）,PredictivevalueforMallampatiscore,thyromentaldistance,sternomentaldistanceandprotrusionofthemandibleaspredictorsofdifficultintubation,BrJAnaesth1994;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)Sternomentaldistance82.488.626.9(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),CanJAnesth2019;52(3):291296.,Forty-twostudiesenrolling34,513patientswereincluded.Forpredictingdifficultlaryngoscopy,bothversionsoftheMallampatitesthadgoodaccuracy.Forpredictingdifficultintubation,themodifiedMallampatitesthadgoodaccuracy.Usedalone,theMallampatitestshavelimitedaccuracyforpredictingthedifficultairwayandthusarenotusefulscreeningtests.,AnesthAnalg.2019;102(6):1867-78.,Thirty-fivestudies(50,760patients)ThemostusefulbedsidetestforpredictionwasfoundtobeacombinationoftheMallampaticlassificationandthyromentaldistance.,Anesthes