■许多研究人员已经研究了可以独立预测悬吊喉镜检查中困难的喉部暴露(DLE)的参数;但是,以前的研究报告了不一致的结果和结论.我们对现有文献进行了荟萃分析,以确定对标准化术前DLE预测系统有意义的参数。
■文献是从PubMed系统检索的,Embase,WebofScience,中国国家知识基础设施(CNKI),和王芳,直到2022年10月。在符合条件的研究中,使用R语言对数据进行提取和分析,有效的衡量标准是二分变量具有95%置信区间(CI)的比值比和连续变量具有95%CI的平均差(MD).
■搜索产生了1574项研究,其中18例包括2263例患者。汇总分析表明,在显微手术期间患有DLE的患者通常是男性(OR=1.73,95%CI=[1.16,2.57]);年龄较大(MD=5.47岁,95%CI=[2.44,8.51]);高体重指数(BMI;MD=1.19Kg/m2,95%CI=[0.33,2.05]);牛颈(MD=2.50cm,95%CI=[1.56,3.44]);张口受限(MD=-0.52cm,95%CI=[-0.88,-0.15]);颈部柔韧性有限(MD=-10.05cm,95%CI=[-14.10,-6.00]);具体的解剖学特征;以及改良的Mallampati指数或检验(OR=3.37,95%CI=[2.07,5.48])。
■我们的研究对DLE相关因素进行了全面系统的分析。性别,年龄,体重指数(BMI),颈围(NC),修改后的Mallampati指数(MMI),切牙间隙(IIG),舌骨-心理距离(HMD),甲状腺-心理距离(TMD),心理距离(SMD),和屈伸角度最终被确定为DLE的高度相关因素。
OBJECTIVE: Considerable research has been focused on independent predictors of difficult laryngeal exposure (DLE) during suspension laryngoscopy. However, previous studies have yielded inconsistent results and conclusions. Consequently, we performed a meta-analysis of the existing literature with the aim of identifying significant parameters for a standardized preoperative DLE prediction system.
METHODS: We systematically retrieved articles from the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to October 2022. Data from eligible studies were extracted and analyzed using the R programming language. The effect measures included odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous variables and mean differences (MDs) with 95% CIs for continuous variables.
RESULTS: The search yielded 1,574 studies, of which 18 (involving a total of 2,263 patients) were included. Pooled analysis demonstrated that patients with DLE during microsurgery tended to be male (OR, 1.73; 95% CI, 1.16-2.57); were older (MD, 5.47 years, 95% CI, 2.44-8.51 years); had a higher body mass index (BMI; MD, 1.19 kg/m2; 95% CI, 0.33-2.05 kg/m2); had a greater neck circumference (MD, 2.50 cm; 95% CI, 1.56-3.44 cm); exhibited limited mouth opening (MD, -0.52 cm; 95% CI, -0.88 to -0.15 cm); had limited neck flexibility (MD, -10.05 cm; 95% CI, -14.10 to -6.00 cm); displayed various other anatomical characteristics; and had a high modified Mallampati index (MMI) or test score (OR, 3.37; 95% CI, 2.07-5.48).
CONCLUSIONS: We conducted a comprehensive and systematic analysis of the factors relevant to DLE. Ultimately, we identified sex, age, BMI, neck circumference, MMI, inter-incisor gap, hyomental distance, thyromental distance, sternomental distance, and flexion-extension angle as factors highly correlated with DLE.