發(fā)布時(shí)間：2018-01-24 06:58

  本文關(guān)鍵詞： 超聲 顳下頦關(guān)節(jié)活動(dòng)度 全身麻醉 氣管插管 困難氣道　出處：《皖南醫(yī)學(xué)院》2016年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:運(yùn)用超聲測(cè)量下頜骨髁狀突的活動(dòng)度是一種新型、可靠的評(píng)估顳下頦關(guān)節(jié)(temporomandibular joint,TMJ)活動(dòng)度的方法。然而,與其他相關(guān)預(yù)測(cè)困難氣道的方法相比,運(yùn)用超聲測(cè)量出的下頜骨髁狀突的活動(dòng)度受限是否可以準(zhǔn)確地預(yù)測(cè)困難氣道,尤其是喉鏡顯露困難,還不得而知。本研究就是為了觀察運(yùn)用超聲測(cè)量下頜骨髁狀突的活動(dòng)度預(yù)測(cè)喉鏡顯露困難的能力。方法:選擇擬在全身麻醉氣管插管下行擇期手術(shù)的成年患者600例,排除頜面部創(chuàng)傷、無(wú)牙、不能完全配合的患者。運(yùn)用超聲測(cè)量所有納入標(biāo)準(zhǔn)患者的髁狀突的移動(dòng)距離來(lái)評(píng)估其下頜骨髁狀突的活動(dòng)度。同時(shí)于全身麻醉前測(cè)量其他反映顳下頦關(guān)節(jié)活動(dòng)度的預(yù)測(cè)指標(biāo),如張口度、下門(mén)齒前伸距離、咬上嘴唇分級(jí)。誘導(dǎo)后行氣管插管,觀察每個(gè)納入標(biāo)準(zhǔn)患者的喉鏡顯露分級(jí)(Cormack-Lehane level)。結(jié)果:本研究共納入536例患者,其中,喉鏡顯露困難者(Cormack-Lehane level2)47例。運(yùn)用Youden指數(shù)確立的超聲測(cè)量髁狀突活動(dòng)度預(yù)測(cè)困難喉鏡顯露的最佳預(yù)測(cè)標(biāo)準(zhǔn)是髁狀突的移動(dòng)距離≤10mm。在以上所有的這些預(yù)測(cè)標(biāo)準(zhǔn)中,髁狀突的移動(dòng)距離與喉鏡顯露分級(jí)之間具有最高的相關(guān)性(r=-0.467,P0.001),與喉鏡顯露困難的受試者工作特征(receiver operating characteristic curve,ROC)曲線(xiàn)下的面積最大(0.958)。同時(shí),配對(duì)卡方檢驗(yàn)與一致性測(cè)試顯示:髁狀突移動(dòng)距離≤10mm與困難喉鏡顯露之間具有最高的kappa值(Kappa=0.687,95%CI:0.586-0.788)。在OR值方面,髁狀突活動(dòng)受限具有最高的預(yù)測(cè)價(jià)值:OR值為122(95%CI:47-313),敏感度為0.872(95%CI:0.743-0.952),特異度為0.947(95%CI:0.923-0.965),陽(yáng)性預(yù)測(cè)值為0.612(95%CI:0.484-0.725),陰性預(yù)測(cè)值為0.987(95%CI:0.972-0.995)。結(jié)論:運(yùn)用超聲測(cè)得的下頜骨髁狀突活動(dòng)度可以有效地預(yù)測(cè)困難喉鏡顯露,且具有較高的預(yù)測(cè)價(jià)值。
[Abstract]:Objective: to measure the motion of mandibular condyle by ultrasound is a new and reliable method to evaluate temporomandibular joint of mandibular condyle. However, compared with other relevant methods for predicting difficult airway, whether the condylar movement of the mandibular condyle measured by ultrasound can accurately predict the difficult airway. In particular, laryngoscope is difficult to expose. The purpose of this study was to observe the ability of ultrasound to measure the movement of the mandibular condyle to predict the difficulty of laryngoscope exposure. 600 adult patients undergoing elective surgery under general anesthesia and tracheal intubation were selected. Excluded maxillofacial trauma, edentulous. Measure the movement distance of condyle of all the standard patients by using ultrasound to evaluate the movement of mandibular condyle. Also measure other movements of the temporomandial joint before general anesthesia. To predict. Such as mouth opening, lower incisor forward extension distance, bite lip grading. After induction endotracheal intubation. Results: 536 patients were included in this study. Laryngoscope exposure difficulty: Cormack-Lehane level 2). 47 cases. The best predictor of difficult laryngoscope exposure using Youden index is the movement distance of condyle 鈮，

本文編號(hào)：1459444