这位患者是否难以输管? : 理性的临床检查系统审查
Michael E Detsky1,2, Naheed Jivraj3,4, Neill K Adhikari2,3,5
1Department of Medicine, Sinai Health System, Toronto, Ontario, Canada.
JAMA
|February 6, 2019
概括
预测难以进行内管道输入对于患者安全至关重要. 上唇咬伤测试和口腔距离是关键指标,尽管没有一个测试可靠地排除了困难的呼吸道.
科学领域:
- 麻醉学和重症监护医学
- 气道管理
- 预测诊断
背景情况:
- 难以进行内管道输入对患者构成重大风险.
- 早期识别可能出现呼吸道困难的患者对于准备工作至关重要.
- 准确的预测可以及时提供援助和部署先进的呼吸道设备.
研究的目的:
- 确定临床风险因素和身体检查结果,准确预测难以输内管道输入.
- 在元分析中评估各种临床预测的诊断准确性.
主要方法:
- 62项高质量研究的系统审查和元分析 (证据1-3级).
- 搜索数据库:MEDLINE和EMBASE (1946年至2018年).
- 用于诊断准确性的元分析的双变和单变随机效应模型.
主要成果:
- 在审查的研究中,大约10%的患者出现了难以输管的情况.
- 预测性发现包括:上唇咬伤测试 (3级),短下唇距离 (<5. 5厘米),逆位,以及威尔逊分数.
- 与其他发现相比,修改后的Mallampati评分 (≥3) 的预测准确性较低.
结论:
- 一些简单的临床发现有效地预测了难以输管的更高可能性.
- 没有任何单一的临床发现可以明确排除呼吸道困难的可能性.
- 一个异常的上唇咬伤测试显著增加了难以输管的概率,从10%增加到60%以上.
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