如何预测困难气管插管课件

如何预测困难气管插管?

HowtoPredictDifficultIntubation四川大学华西医院麻醉科TroublewithAirwayDefinitionTeststodeterminedifficultintubationareforlaryngoscopyandmaynotapplytoalldevicesDifficultintubationvsDifficultlaryngoscopyMaynotseecordsyetbeabletointubationMayseecordsandnotbeabletointubationCormack&Lehane喉镜暴露分级未预计的困难气管插管对麻醉医生是一种挑战。是否可以通过简单的床旁体检来预测困难气管插管？

LEMON

法则

Lookexternally.

Evaluatethe3-3-2rule.

Mallampati.

Obstruction?

Neckmobility.LookExternally

（外观检查）肥胖（Obesity）颈短粗（Shortbullneck）高腭弓（Higharchingpalate）上门牙突出（ProminentUpperIncisors，BuckTeeth）小下颌（Recedingmandible，Dentures）无牙（Edentulousmouth）面部畸形（Abnormalfacialshape）面部创伤（Facialtrauma）Evaluatethe3-3-2rule

（3-3-2法则）3fingersbetweenthepatient’steeth(patient’smouthshouldopenadequatelytopermitthreefingerstobeplacedbetweentheupperandlowerteeth)3fingersbetweenthetipofthejawandthebeginningoftheneck(underthechin)2fingersbetweenthethyroidnotchandthefloorofthemandible(topoftheneck)改良Mallampati分级Obstruction?

（是否存在梗阻因素）肿瘤脓肿血肿会厌炎甲状腺肿大NeckMobility

（颈椎活动度）气道评估指标Anesthesiology2003;98:1269-77.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EurJAnaesthesiol2001;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.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（下颌前突）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-fivestudie