斜坡位改变环状软骨压迫与左侧气管旁压迫对肥胖成人视频喉镜下声门视野质量感知的影响：一项基于图像的二次分析
Ramped positioning modifies the effect of cricoid and left paratracheal pressure on perceived glottic-view quality during videolaryngoscopy in adults with obesity: a secondary image-based analysis.
文献信息
| PMID | 42772420 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Benjamin Javillier |
| 作者单位 | Department of Anaesthesia, Clinique Saint-Luc de Bouge, Namur, Belgium; Department of Anaesthesia, Liege University, Liege, Belgium. Electronic address: javillier.benjamin@hotmail.com. |
| 期刊 | Anaesthesia, critical care & pain medicine |
| SCI 分区 | Q1 |
| IF | 4.6 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 在肥胖成人中，视频喉镜（VL）检查时患者体位与外部喉部压迫的联合效应仍不明确。我们评估了斜坡位是否改变无压迫（NP）、左侧气管旁压迫（LPP）和环状软骨压迫（CP）对声门视野质量感知的影响。
方法： 这项回顾性、基于图像的二次分析纳入了91名肥胖成人的去标识化VL图像，分为六种操作-体位组合：仰卧位或快速气道管理体位（RAMP），每种体位分别配合无压迫、左侧气管旁压迫或环状软骨压迫。盲法麻醉临床医生采用三点量表对声门视野质量感知进行评分。评分采用累积有序模型分析，包含阈值特异性效应，并以评分者为聚类单位使用稳健标准误。
结果： 我们分析了来自340名评分者对273张图像的59,956次评分。NP在两种体位中均产生最高比例的良好评分。在仰卧位，LPP的评分优于CP；而在斜坡位，CP和LPP产生大致相似的良好评分比例，尽管存在统计学显著但绝对值较小的差异。CP×RAMP交互作用表明，在斜坡位中CP相关的不良效应被减弱。评分者间一致性为中等至一般。
结论： 在肥胖成人中，斜坡位改变了外部喉部压迫对VL期间声门视野质量感知的影响。NP总体上产生最良好的评分。当需要CP时，斜坡位可能减轻其对声门视野质量感知的不良影响。有必要开展采用临床结局的前瞻性研究。
英文摘要
BACKGROUND: In adults with obesity, the combined effect of patient positioning and external laryngeal compression during videolaryngoscopy (VL) remains unclear. We assessed whether ramped positioning modifies the perceived effects of no pressure (NP), left paratracheal pressure (LPP), and cricoid pressure (CP) on perceived glottic-view quality.
METHODS: This retrospective, image-based secondary analysis included de-identified VL images from 91 adults with obesity, grouped into six manoeuvre-position combinations: supine or Rapid Airway Management Position (RAMP), each with no pressure, left paratracheal pressure, or cricoid pressure. Blinded anaesthesia clinicians rated perceived glottic-view quality on a three-point scale. Ratings were analysed using cumulative ordinal models with threshold-specific effects and robust standard errors clustered by rater.
RESULTS: We analysed 59,956 ratings from 340 raters across 273 images. NP yielded the highest proportion of favourable ratings in both positions. In the supine position, LPP was rated more favourably than CP, whereas in the ramped position, CP and LPP produced broadly similar proportions of favourable ratings despite a statistically significant but small absolute difference. The CP × RAMP interaction indicated attenuation of the adverse CP-associated effect in the ramped position. Inter-rater agreement was fair to moderate.
CONCLUSIONS: In adults with obesity, ramped positioning modified the effect of external laryngeal compression on perceived glottic-view quality during VL. NP yielded the most favourable ratings overall. When CP is required, ramped positioning may mitigate its adverse effect on perceived glottic-view quality. Prospective studies using clinical outcomes are warranted.