如何预测困难气管插管讲稿.ppt

如何预测困难气管插管第一页，讲稿共二十四页哦Trouble with Airway DefinitionTests to determine difficult intubation are for Tests to determine difficult intubation are for laryngoscopy and may not apply to all deviceslaryngoscopy and may not apply to all devicesDifficult intubation vs Difficult intubation vs Difficult laryngoscopyDifficult laryngoscopyMay not see cords yet be able to intubationMay not see cords yet be able to intubationMay see cords and not be able to intubationMay see cords and not be able to intubation第二页，讲稿共二十四页哦Cormack&Lehane Cormack&Lehane 喉镜暴露分级喉镜暴露分级喉镜暴露分级喉镜暴露分级第三页，讲稿共二十四页哦未预计的困难气管插管对麻醉医生是一种未预计的困难气管插管对麻醉医生是一种挑战。挑战。是否可以通过简单的床旁体检来预测困难是否可以通过简单的床旁体检来预测困难气管插管？气管插管？第四页，讲稿共二十四页哦 LEMON 法则法则 uu Look externally.uu Evaluate the 3-3-2 rule.uu Mallampati.uu Obstruction?uu Neck mobility.第五页，讲稿共二十四页哦Look Externally（外观检查）（外观检查）肥胖（肥胖（肥胖（肥胖（ObesityObesity）颈短粗（颈短粗（颈短粗（颈短粗（Short bull neckShort bull neck）高腭弓（高腭弓（高腭弓（高腭弓（High arching palateHigh arching palate）上门牙突出（上门牙突出（上门牙突出（上门牙突出（Prominent Upper IncisorsProminent Upper Incisors，Buck TeethBuck Teeth）小下颌（小下颌（小下颌（小下颌（Receding mandibleReceding mandible，DenturesDentures）无牙（无牙（无牙（无牙（Edentulous mouthEdentulous mouth）面部畸形（面部畸形（面部畸形（面部畸形（Abnormal facial shapeAbnormal facial shape）面部创伤（面部创伤（面部创伤（面部创伤（Facial traumaFacial trauma）第六页，讲稿共二十四页哦Evaluate the 3-3-2 rule（3-3-2法则）法则）3 fingers between the patients 3 fingers between the patients teeth(patients mouth should teeth(patients mouth should open adequately to permit three open adequately to permit three fingers to be placed between the fingers to be placed between the upper and lower teeth)upper and lower teeth)3 fingers between the tip of the 3 fingers between the tip of the jaw and the beginning of the neck jaw and the beginning of the neck(under the chin)(under the chin)2 fingers between the thyroid notch 2 fingers between the thyroid notch and the floor of the mandible(top of and the floor of the mandible(top of the neck)the neck)第七页，讲稿共二十四页哦改良改良Mallampati分级分级第八页，讲稿共二十四页哦Obstruction?（是否存在梗阻因素）（是否存在梗阻因素）肿瘤肿瘤脓肿脓肿血肿血肿会厌炎会厌炎甲状腺肿大甲状腺肿大第九页，讲稿共二十四页哦Neck Mobility（颈椎活动度）（颈椎活动度）第十页，讲稿共二十四页哦气道评估指标气道评估指标Anesthesiology 2003;98:1269-77.Anesthesiology 2003;98:1269-77.第十一页，讲稿共二十四页哦Wilson Index（Wilson 指数）指数）Br J Anaesth 1988;61:211-6.Br J Anaesth 1988;61:211-6.第十二页，讲稿共二十四页哦两个距离指标两个距离指标1.1.1.1.甲甲甲甲-颏距离颏距离颏距离颏距离 6 cm6 cm6 cm6 cm2.2.2.2.胸胸胸胸-甲距离甲距离甲距离甲距离 12.5 cm12.5 cm12.5 cm12.5 cm第十三页，讲稿共二十四页哦困难气管插管的解剖机制困难气管插管的解剖机制Eur J Anaesthesiol 2001;18:3-12.Eur J Anaesthesiol 2001;18:3-12.第十四页，讲稿共二十四页哦如何评估困难气管插管预测指标如何评估困难气管插管预测指标第十五页，讲稿共二十四页哦Upper Lip Bite Test（咬上嘴唇试验）（咬上嘴唇试验）A,Class I;lower incisors reflecting a bite of the upper lip,making its mucosa entirely invisible.A,Class I;lower incisors reflecting a bite of the upper lip,making its mucosa entirely invisible.B,Class II;lower incisors half-biting the upper lip,making the mucosa partially invisible.B,Class II;lower incisors half-biting the upper lip,making the mucosa partially invisible.C,Class III;lower incisors attempting a bite but totally failing to catch the upper lip.C,Class III;lower incisors attempting a bite but totally failing to catch the upper lip.Anesth Analg 2003;96:595-9.Anesth Analg 2003;96:595-9.第十六页，讲稿共二十四页哦Anesth Analg 2003;96:595-9.Anesth Analg 2003;96:595-9.The upper lip bite test is an acceptable option for predicting difficult intubation The upper lip bite test is an acceptable option for predicting difficult intubation as a simple,single test.as a simple,single test.第十七页，讲稿共二十四页哦Anesth Analg 2005;101:284-9.Anesth Analg 2005;101:284-9.Both tests are poor predictors as single screening tests.Both tests are poor predictors as single screening tests.第十八页，讲稿共二十四页哦The specificity and accuracy of the ULBT is significantly higher than the other tests and The specificity and accuracy of the ULBT is significantly higher than the other tests and is more accurate in airway assessment.is more accurate in airway assessment.However,the ULBT in conjunction with the other tests could more reliably predict easy However,the ULBT in conjunction with the other tests could more reliably predict easy laryngoscopy or intubation.laryngoscopy or intubation.第十九页，讲稿共二十四页哦Comparison of two methods for predicting difficult intubation in Comparison of two methods for predicting difficult intubation in obstetric patientsobstetric patients Comparing modified Mallampati test with Wilson risk sum score in 372 Comparing modified Mallampati test with Wilson risk sum score in 372 obstetric patientsobstetric patients Mallampati class III or IV predicted 15 of the 23 patients while Wilson risk sum score Mallampati class III or IV predicted 15 of the 23 patients while Wilson risk sum score or=2 predicted 9 of the 14 patients in whom tracheal intubation was difficult.or=2 predicted 9 of the 14 patients in whom tracheal intubation was difficult.Middle East J Anesthesiol.2003 Jun;17(2):275-85.Middle East J Anesthesiol.2003 Jun;17(2):275-85.TestSensitivity(%)Specificity(%)Positive predictive value(%)Mallampati score606097.697.66565(grade III or IV)Wilson risk sum score(2)363698.598.56464Combination of two tests10010096.296.264.864.8第二十页，讲稿共二十四页哦Protrusion of the Mandible（下颌前突）（下颌前突）第二十一页，讲稿共二十四页哦Predictive value for Mallampati score,thyromental distance,Predictive value for Mallampati score,thyromental distance,sternomental distance and protrusion of the mandible as sternomental distance and protrusion of the mandible as predictors of difficult intubationpredictors of difficult intubationBr J Anaesth 1994;73:149-53.Br J Anaesth 1994;73:149-53.Test Sensitivity(%)Specificity(%)Positive predictive value(%)Test Sensitivity(%)Specificity(%)Positive predictive value(%)Mallampati scoreMallampati score 64.7 66.1 8.9 64.7 66.1 8.9 (grade III or IV)(grade III or IV)(38.3-85.6)(61.0-71.2)(3.9-13.9)(38.3-85.6)(61.0-71.2)(3.9-13.9)Thyromental distanceThyromental distance 64.7 81.4 15.1 64.7 81.4 15.1 (6.5 cm)(6.5 cm)(38.3-85.6)(77.2-85.6)(7.8-25.4)(38.3-85.6)(77.2-85.6)(7.8-25.4)Sternomental distanceSternomental distance 82.4 88.6 26.982.4 88.6 26.9 (12.5 cm)(12.5 cm)(56.6-96.2)(85.2-92.0)(15.6-41.0)(56.6-96.2)(85.2-92.0)(15.6-41.0)Protrusion of mandibleProtrusion of mandible 29.4 85.0 9.1 29.4 85.0 9.1 (position B or C)(position B or C)(10.3-56.0)(81.2-88.8)(3.0-20.0)(10.3-56.0)(81.2-88.8)(3.0-20.0)第二十二页，讲稿共二十四页哦Can J Anesth 2005;52(3):291296.Can J Anesth 2005;52(3):291296.第二十三页，讲稿共二十四页哦第二十四页，讲稿共二十四页哦