胸骨颏距离预测支撑喉镜检查中的迷走反射：一项前瞻性队列研究。
Sternomental distance predicts vagal reflex during suspension laryngoscopy: A prospective cohort study.
文献信息
| PMID | 42790175 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yijun Dong |
| 作者单位 | Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China. |
| 期刊 | American journal of otolaryngology |
| SCI 分区 | Q2 |
| IF | 1.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 支撑喉镜检查（SL）期间的迷走反射（VR）是一种可能危及生命的并发症。然而，术前风险分层工具仍然缺乏，尤其是对于健康成人。本研究旨在识别SL术中VR的解剖学和临床预测因素，并建立可用于风险分层的可操作阈值。
方法： 这项前瞻性观察性队列研究纳入了2022年1月至2023年12月期间在一家三级学术医院接受全身麻醉下SL的371例成年患者。获取了术前解剖学测量指标，包括胸骨颏距离（SMD）、颈围和甲状腺-下颌角（TMA）。进行了逻辑回归、广义相加模型和分段线性回归分析，以识别独立预测因素并确定VR风险的最佳阈值。
结果： 在这个病例富集队列中（n=371，包括118例有VR和253例无VR），VR阳性组的SMD显著短于VR阴性组（17.01±1.89 cm vs. 17.62±1.90 cm，P=0.004）。多变量分析确定较短的SMD是VR的独立预测因素（校正OR：0.83，95% CI：0.73-0.94，P=0.0033）。确定了18.2 cm的阈值，高于该值时VR风险降低（OR：0.59，95% CI：0.39-0.89，P=0.01）。
结论： 较短的SMD与SL术中VR风险增加独立相关。术前SMD测量可能提供一种简单、无创的方法来识别高风险患者，并指导有针对性的围手术期策略，以提高显微喉手术期间的气道安全性。
英文摘要
OBJECTIVES: Vagal reflex (VR) during suspension laryngoscopy (SL) is a potentially life-threatening complication. However, preoperative risk stratification tools are lacking, especially for healthy adults. This study aimed to identify the anatomical and clinical predictors of intraoperative VR during SL and establish actionable thresholds for risk stratification.
METHODS: This prospective observational cohort study enrolled 371 adult patients who underwent SL under general anesthesia at a tertiary academic hospital between January 2022 and December 2023. Preoperative anatomical measurements, including sternomental distance (SMD), neck circumference, and thyroid-mandibular angle (TMA), were obtained. Logistic regression, generalized additive modeling, and piecewise linear regression analyses were performed to identify independent predictors and determine the optimal threshold for VR risk.
RESULTS: In this case-enriched cohort (n = 371, including 118 with and 253 without VR), SMD was significantly shorter in the VR-positive group than in the VR-negative group (17.01 ± 1.89 cm vs. 17.62 ± 1.90 cm, P = 0.004). Multivariate analysis identified shorter SMD as an independent VR predictor (adjusted OR: 0.83, 95% CI: 0.73-0.94, P = 0.0033). A threshold of 18.2 cm was identified, with reduced VR risk above this value (OR: 0.59, 95% CI: 0.39-0.89, P = 0.01).
CONCLUSION: Shorter SMD was independently associated with an increased risk of intraoperative VR during SL. Preoperative SMD measurement may provide a simple, noninvasive method for identifying high-risk patients and guiding targeted perioperative strategies to enhance airway safety during microlaryngeal surgery.