Article record

视频喉镜下声门视野与气管插管之间的关联：一项前瞻性观察性研究

Association between glottic view and tracheal intubation during videolaryngoscopy: a prospective observational study.

临床研究咽喉科IF 8.4Q1

文献信息

PMID	42823939
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Miguel Ángel Fernández-Vaquero 查看其他 6 位作者 Pedro Charco-Mora；Manuel Ángel Gómez-Ríos；Jose A Sastre；Nekari de Luis-Cabezón；Robert Greif；Marc Vives
作者单位	Department of Anaesthesiology and Critical Care, Clínica Universidad de Navarra, Madrid, Spain. 查看其他 7 条单位信息 School of Medicine, University of Navarra, Pamplona, Spain.；Department of Anaesthesiology and Critical Care, Hospital Universitario y Politécnico La Fe, Valencia, Spain.；Department of Anaesthesiology and Critical Care, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.；Department of Anaesthesiology and Critical Care, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.；Department of Anaesthesiology and Critical Care, Hospital Universitario de Basurto, Bilbao, Spain.；Faculty of Medicine, University of Bern, Bern, Switzerland.；Department of Anaesthesiology and Critical Care, Clínica Universidad de Navarra, Pamplona, Spain.
期刊	Anaesthesia
SCI 分区	Q1
IF	8.4
研究类型	临床研究 · 临床
所属专科	咽喉科

中文摘要

引言： 视频喉镜下良好的声门视野并不总能一致地转化为顺利的气管导管置入，提示可视化与操作执行之间存在分离。当视频喉镜的记录仅基于喉部视野时，它不能可靠地反映气管插管的操作表现。我们评估了这种关系以及视频喉镜气管插管结构化分类框架的可重复性。
方法： 我们在44家医院开展了一项前瞻性多中心观察性研究。视频喉镜气管插管由气道操作者和观察者使用三域分类独立评估：镜片几何形状；使用声门开放百分比（POGO）评分的声门视野；以及气管导管置入。评估了评分者间信度。在预定义的POGO类别中分析了声门视野与气管导管置入之间的关系。
结果： 共分析了5302例具有配对评估的气管插管。三域分类的总体评分者间一致性较高（Krippendorff's α = 0.86，95%CI 0.85-0.87）。在视野不佳（POGO < 25%）的气管插管中，37/151（24.5%）被归类为容易。在POGO ≥ 25%的气管插管中，527/5151（10.2%）被归类为困难或失败。即使在声门视野极佳（POGO > 75%）的情况下，初始策略仍有252/4025（6.3%）的病例被归类为困难或失败。
讨论： 视频喉镜下气管插管的难易程度不能仅从声门视野推断。一种纳入所用器械、所见情况和所做操作的结构化方法可能改善临床实践中的沟通。

英文摘要

INTRODUCTION: A good view of the glottis with videolaryngoscopy does not translate consistently into straightforward tracheal tube delivery, suggesting a dissociation between visualisation and procedural execution. When videolaryngoscopy documentation is based on laryngeal view alone, it does not reliably reflect the performance of tracheal intubation. We evaluated this relationship and the reproducibility of a structured classification framework for videolaryngoscopic tracheal intubation.
METHODS: We conducted a prospective multicentre observational study across 44 hospitals. Videolaryngoscopic tracheal intubations were assessed independently by an airway operator and an observer using a three-domain classification: blade geometry; glottic view using the percentage of glottic opening (POGO) score; and tracheal tube delivery. Inter-rater reliability was assessed. The relationship between glottic view and tracheal tube delivery was analysed across predefined POGO categories.
RESULTS: A total of 5302 tracheal intubations with paired assessments were analysed. The overall inter-rater agreement for the three-domain classification was high (Krippendorff's α = 0.86, 95%CI 0.85-0.87). Among tracheal intubations with poor view (POGO < 25%), 37/151 (24.5%) were classified as easy. Among tracheal intubations with POGO ≥ 25%, 527/5151 (10.2%) were classified as difficult or failed. Even with excellent glottic view (POGO > 75%), the initial strategy was classified as difficult or failed in 252/4025 (6.3%) of cases.
DISCUSSION: The ease of tracheal intubation with videolaryngoscopy cannot be inferred from glottic view alone. A structured approach that incorporates what was used, what was seen and what was done may improve communication in clinical practice.