| 摘要: |
| 目的 分析与可视喉镜暴露声门困难相关的面部特征指标。方法 选择2020年8月至10月在上海交通大学医学院附属第九人民医院拟接受全身麻醉下颅颌面手术且行气管插管的患者537例作为研究对象，患者的美国麻醉医师学会（ASA）分级为Ⅰ~Ⅱ级。手术麻醉前获取患者年龄、性别、身高、体重、BMI等信息，采集患者正面中立位、张口伸舌及仰头姿势的照片，并对标注的面部特征进行定量化分析。麻醉医师用统一规格可视喉镜实施气管插管时，由统计者记录暴露声门的Cormack-Lehane（C-L）等级。根据C-L等级将患者分为可视喉镜暴露声门容易组（C-L等级Ⅰ~Ⅱ级）和可视喉镜暴露声门困难组（C-L等级Ⅲ~Ⅳ级）。对可视喉镜暴露声门困难者基于年龄（差异不大于2岁）和性别与可视喉镜暴露容易者1∶1匹配，对两组患者的面部特征指标与可视喉镜暴露声门的真实结果进行多因素logistic回归分析，归纳具有评估作用的阳性指标。结果 成功匹配31对患者，年龄为15~75岁，可视喉镜暴露困难组年龄为（49.29±17.47）岁，可视喉镜暴露容易组年龄为（49.23±17.47）岁，两组BMI差异无统计学意义[（22.18±3.55）kg/m2 vs（23.33±3.06）kg/m2，P>0.05]。面部特征中，眉心至鼻尖距离占额骨鳞部体表冠状面顶点处至下颏距离比例和伸舌受限在两组间差异有统计学意义（P均< 0.01）。多因素logistic回归分析发现，眉心至鼻尖距离占额骨鳞部体表冠状面顶点处至下颏距离比例与可视喉镜暴露声门困难的发生有关（OR=1.25，95%CI 1.02~1.53，P < 0.05）。结论 可视喉镜暴露声门困难的患者存在一些区别于暴露声门容易患者的面部特征，可视喉镜暴露声门困难的患者更容易存在眉心至鼻尖距离占比增大的面部特征。 |
| 关键词: 面部图像分析 可视喉镜检查 喉镜暴露困难 气管插管 |
| DOI：10.16781/j.0258-879x.2021.12.1382 |
| 投稿时间：2021-04-24 |
| 基金项目:上海申康医院发展中心第二轮临床三年行动计划（SHDC2020CR3043B），上海交通大学医学院附属第九人民医院临床研究助力计划（JYLJ202013） |
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| Analysis of facial features related to difficult visual laryngoscopic glottis exposure |
| WANG Jie,XIA Ming,ZHOU Ren,CAO Shuang,XU Tian-yi,JIANG Hong* |
(Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the facial feature indexes related to difficult visual laryngoscopic glottis exposure.Methods A total of 537 patients who underwent craniomaxillofacial surgery and tracheal intubation under general anesthesia were recruited from Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from Aug. to Oct. 2020, with American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅱ. The age, gender, height, weight and body mass index (BMI) of patients were obtained before anesthesia, and the photographs of patients in frontal neutral position, mouth opening with tongue extending position and head-up position were collected to quantify labeled facial features. When anesthesiologists performed tracheal intubation with a unified visual laryngoscope, the Cormack-Lehane (C-L) grade was recorded by the statistician. Subjects were assigned to easy visual laryngoscopic glottis exposure group (C-L grade Ⅰ-Ⅱ) or difficult visual laryngoscopic glottis exposure group (C-L grade Ⅲ-Ⅳ) according to the C-L grade. Subjects in the difficult group were matched 1:1 with those in the easy group based on age (difference of no more than 2 years) and gender. The facial feature indexes of the 2 groups were analyzed with the real results of visual laryngoscopic glottis exposure by multivariate logistic regression analysis to summarize the positive indexes useful for assessment.Results Thirty-one pairs of subjects were successfully matched with an age ranged from 15 to 75 years. The age of the difficult group and easy group was (49.29±17.47) and (49.23±17.47) years, respectively, and there was no significant difference in BMI between the 2 groups ([22.18±3.55] kg/m2 vs[23.33±3.06] kg/m2, P>0.05). For the facial features, the proportion of the distance from brow to nasal tip to the distance from the apex of the coronal surface of the frontal scale to the chin and the restriction of tongue extension were significantly different between the 2 groups (both P < 0.01). Multivariate logistic regression analysis found that the proportion of the distance from brow to nasal tip to the distance from the apex of the coronal surface of the frontal scale to the chin was significantly related to difficult laryngoscopic exposure (odds ratio[OR]=1.25, 95% confidence interval[CI] 1.02-1.53, P < 0.05).Conclusion Patients who have difficulty in glottic exposure with visual laryngoscope have some facial features that are different from easy exposure patients. They are more likely to have facial features with an increased proportion of brow to tip distance. |
| Key words: facial image analysis visual laryngoscopy difficult laryngoscopic exposure tracheal intubation |
