目的:确定理想的头部位置,以使用柔性喉镜优化声门下的可视化。
方法:前瞻性队列研究。
方法:三级护理中心的门诊多学科气道诊所。
方法:纳入到多学科气道诊所接受鼻内镜气道检查的患者。在喉镜检查期间使用三个头部位置检查声门下:“嗅探,\“下巴塞,弯腰的姿势。办公室评审员和盲目的临床医生参与者根据Cormack-Lehane(CL)量表评估了气道的观点,气道等级(AG),和视觉模拟量表(VAS)。获得了人口统计数据。统计分析使用学生t检验比较了头部位置和人口统计数据,方差分析,和Tukey的事后分析。
结果:100名患者参加。在任何头部位置的CL评分的临床或盲目组之间没有统计学差异(分别为p=.35,.5)。对于AG和VAS,临床和盲检人员对弯曲和弯腰位置的评分均高于嗅探位置(所有分析的p<0.01),但这两个位置之间没有统计学差异(分别为p=.28,.18)。两组审稿人的年龄与柔性位置的AG和VAS评分呈负相关(分别为p=.02,<.01),较高的体重指数与需要进行气管镜检查以进行全气道评估显着相关(p<.01)。
结论:屈曲和弯腰两种姿势都可以由经验丰富的内窥镜医师在清醒时实施,经鼻柔性喉镜检查可增强声门下气道的可视化。
OBJECTIVE: Determine the ideal head position to optimize visualization of the
subglottis using flexible laryngoscopy.
METHODS: Prospective cohort study.
METHODS: Outpatient multidisciplinary airway clinic at a tertiary care center.
METHODS: Patients presenting to a multidisciplinary airway clinic undergoing nasoendoscopic airway examination were enrolled. Three head positions were utilized to examine the
subglottis during laryngoscopy: \"sniffing,\" chin tuck, and stooping positions. In-office reviewers and blinded clinician participants evaluated views of the airway based on Cormack-Lehane (CL) scale, airway grade (AG), and visual analog scale (VAS). Demographic data were obtained. Statistical analysis compared head positions and demographic data using Student\'s t test, analysis of variance, and Tukey\'s post hoc analysis.
RESULTS: One hundred patients participated. No statistical differences existed among in-clinic or blinded reviewers for the CL score in any head position (p = .35, .5, respectively). For both AG and VAS, flexed and stooping positions were rated higher than the sniffing positions by both in-clinic and blinded reviewers (p < .01 for all analyses), but there was no statistical difference between these two positions (p = .28, .18, respectively). There was an inverse correlation between age and scores for AG and VAS in the flexed position for both sets of reviewers (p = .02, <.01 respectively), and a higher body mass index was significantly associated with the need to perform tracheoscopy for full airway evaluation (p < .01).
CONCLUSIONS: Both flexion and stoop postures can be implemented by an experienced endoscopist in awake, transnasal flexible laryngoscopy to enhance visualization of the subglottic airway.