超声测量的皮肤至会厌深度随解剖水平变化及其对困难喉镜暴露的诊断效能：一项前瞻性观察性研究

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中文摘要

背景与目的： 超声测量的皮肤至会厌深度（SED）已被提出作为困难喉镜暴露（DL）的预测指标。大多数研究评估的是单一解剖水平上的横向测量，而旁矢状面成像及测量水平对诊断效能的影响仍不明确。本研究旨在评估旁矢状面SED随解剖水平的变化，并比较其预测DL的诊断准确性。
方法： 在这项前瞻性观察性研究中，对150例在全身麻醉下接受择期手术的成年患者进行了术前评估。在三个解剖标志处测量旁矢状面SED：舌骨上缘（HUB）、舌骨下缘（HLB）和甲状舌骨膜（THM）。困难喉镜暴露定义为Cormack-Lehane III-IV级。采用受试者工作特征分析评估诊断效能。
结果： 32例患者（21.3%）发生DL。旁矢状面SED在不同解剖水平间存在显著差异。HUB测量显示出优于HLB（AUC 0.75）和THM（AUC 0.65）的预测效能[曲线下面积（AUC）0.86；95%置信区间0.79-0.92]。HUB/THM比值显示出相似的高区分度（AUC 0.86）。传统气道测试显示出中等预测价值（AUC 0.62-0.72）。多变量分析确定HUB SED >24 mm、切牙间距≤4 cm以及上唇咬合试验II-III级为DL的独立预测因素。
结论： 旁矢状面SED表现出随解剖水平变化的变异性，这会影响诊断效能。在舌骨上缘进行评估可提供最高的区分度，并可能改善基于超声的气道风险分层。

英文摘要

BACKGROUND AND AIMS: Ultrasonographic skin-to-epiglottis depth (SED) has been proposed as a predictor of difficult laryngoscopy (DL). Most studies have evaluated transverse measurements at a single anatomical level, and the influence of parasagittal imaging and measurement level on diagnostic performance remains unclear. This study aimed to assess anatomical level-dependent variation in parasagittal SED and to compare its diagnostic accuracy for predicting DL.
METHODS: In this prospective observational study, 150 adult patients undergoing elective surgery under general anaesthesia were evaluated preoperatively. Parasagittal SED was measured at three anatomical landmarks: the upper hyoid border (HUB), lower hyoid border (HLB), and thyrohyoid membrane (THM). Difficult laryngoscopy was defined as Cormack-Lehane grade III-IV. Diagnostic performance was analysed using receiver operating characteristic analysis.
RESULTS: DL occurred in 32 patients (21.3%). Parasagittal SED differed significantly across anatomical levels. HUB measurements demonstrated superior predictive performance [area under the curve (AUC) 0.86; 95% confidence interval 0.79-0.92] compared with HLB (AUC 0.75) and THM (AUC 0.65). The HUB/THM ratio showed similarly high discrimination (AUC 0.86). Conventional airway tests showed modest predictive values (AUC 0.62-0.72). Multivariable analysis identified HUB SED >24 mm, inter-incisor distance ≤4 cm, and upper lip bite test class II-III as independent predictors of DL.
CONCLUSION: Parasagittal SED demonstrates anatomical level-dependent variability that affects diagnostic performance. Assessment at the upper hyoid border provides the highest discrimination and may improve ultrasound-based airway risk stratification.