CN110313944A - A kind of method of the data processing of air flue measurement - Google Patents
A kind of method of the data processing of air flue measurement Download PDFInfo
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- CN110313944A CN110313944A CN201910558927.XA CN201910558927A CN110313944A CN 110313944 A CN110313944 A CN 110313944A CN 201910558927 A CN201910558927 A CN 201910558927A CN 110313944 A CN110313944 A CN 110313944A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
- A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
- A61B5/1075—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions by non-invasive methods, e.g. for determining thickness of tissue layer
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0858—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving measuring tissue layers, e.g. skin, interfaces
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Abstract
The present invention relates to a kind of data processing methods of air flue measurement, including obtain the first air flue data, obtain mouth opening data, first chin data and neck mobility data；Other center thyroid cartilage upper limb plane thyroid cartilage is obtained to the distance between epiglottis data；Obtain Cormack-Lehane ranked data；Statistical analysis is carried out to above-mentioned data.Method accuracy of the invention is high, avoid single-measurement issuable inaccuracy problem.
Description
Technical field
The present invention relates to medicine technology fields, and are more particularly related to a kind of data processing method of air flue measurement.
Background technique
The study found that air flue assessment is the pith of preoperative evaluation, and it is preoperative to be assessed without air flue, 25% in catheterization procedure
~30% case can meet difficulty, and when difficult intubation and lack adequate preparation, will lead to patient and cerebral anoxia or heartbeat occurs
The severe complications such as all standing.The preceding accurate air flue assessment of anesthesia facilitates Anesthetist and identifies difficult airway, to carry out appropriately
Airway management reduces the generation of adverse consequences.Difficult laryngoscope exposure is the most immediate cause of tracheal intubation difficulty, and most
Tracheal intubation difficulty all originate from the exception of patient anatomy.With the improvement of airway devices, patient's supervision etc., reduce not
The difficult airway bring risk of prediction, but not reduce the incidence for the difficult airway that do not predict.
Clinically predict that there are many method of difficult airway at present, including Mallampati classification, neck mobility, mouth opening
With first chin distance etc., but reliable and stable conclusion cannot be obtained.
Based on this, the prior art is still to be improved.
Summary of the invention
The present invention is in view of the above-mentioned problems, be designed to provide a kind of data processing method of air flue measurement, the convenient, nothing of energy
The prediction for invasively realizing difficult airway guarantees the safety of patient, and the accuracy and specificity predicted are preferable.
In order to achieve the above objectives, the present invention adopts the following technical scheme:
Embodiment of the invention discloses a kind of data processing methods of air flue measurement, comprising:
Step 1 obtains the first air flue data, obtains mouth opening data, first chin data and neck mobility data；
Step 2 obtains other center thyroid cartilage upper limb plane thyroid cartilage to the distance between epiglottis data；
Step 3 obtains Cormack-Lehane ranked data；
Step 4 will be Step 1: the data of step 2 and step 3 carry out statistical analysis；
Step 5 utilizes the data in ROC curve evaluation procedure two.
It further, further include obtaining Mallampati ranked data.
Further, further include step 6, the data of the Mallampati ranked data and the step 2 are combined
Processing obtains air flue classification results.
Further, in the step 2, other center thyroid cartilage upper limb plane thyroid cartilage is obtained between epiglottis
Range data are as follows:
The distance between epiglottis is arrived by the other center thyroid cartilage upper limb plane thyroid cartilage of measurement, and the first shape is soft
The distance between bone upper limb plane thyroid cartilage and the epiglottis line are perpendicular to skin surface.
Further, the measurement thyroid cartilage upper limb plane thyroid cartilage to the distance between epiglottis be ultrasonic measurement first
Shape cartilage upper limb plane thyroid cartilage arrives the distance between epiglottis.
The invention also discloses a kind of methods for predicting difficult airway, soft by measurement thyroid cartilage upper limb plane first shape
Bone arrives the distance between epiglottis, and the distance between the thyroid cartilage upper limb plane thyroid cartilage and the epiglottis line hang down
Directly in skin surface；
When the distance between described thyroid cartilage upper limb plane thyroid cartilage to epiglottis is in >=8.55mm, it is judged as tired
Difficult air flue；
When the distance between described thyroid cartilage upper limb plane thyroid cartilage to epiglottis is in < 8.55mm, it is judged as normal
Air flue.
Further, the measurement thyroid cartilage upper limb plane thyroid cartilage to the distance between epiglottis be ultrasonic measurement first
Shape cartilage upper limb plane arrives the distance between epiglottis.
Further, the ultrasonic measurement thyroid cartilage upper limb plane thyroid cartilage to the distance between epiglottis for through it is other just
Middle mistake shape position ultrasonic measurement.
Further, it is center by throat, other center, left side or right side that shape position is lost in the other center.
Further, side is hit exactly on the left of the throat or right side side center is that open to the left or 0.8- is opened on side to the right by side for middle line
1.2cm。
Further, side is hit exactly on the left of the throat or right side side center is that open to the left or 1cm is opened on side to the right by side for middle line.
Further, when ultrasonic measurement, the epiglottis is the interface of epiglottis rear air and mucous membrane.
Further, it is measured after going pillow to lie down measured object.
The beneficial effects of the present invention are:
The data processing method measured using air flue of the invention, the height of reliability height, susceptibility, easy to detect, patient
No pain, it is simple and easy, the special compounding of patient is not needed, the measurement that can be effectively reduced the fitness due to patient and generate misses
Difference.
Detailed description of the invention
Fig. 1 is the flow chart of one embodiment of the invention；
Fig. 2, Fig. 3 are the schematic diagram of one embodiment of the invention.
Specific embodiment
In order to make the objectives, technical solutions, and advantages of the present invention clearer, with reference to the accompanying drawings and embodiments, right
The present invention is further elaborated.It should be appreciated that described herein, specific examples are only used to explain the present invention, not
For limiting the present invention.
As shown in Figure 1, one embodiment of the invention discloses a kind of data processing method of air flue measurement, comprising:
Step 1 obtains the first air flue data, obtains mouth opening data, first chin data and neck mobility data；
Step 2 obtains other center thyroid cartilage upper limb plane thyroid cartilage to the distance between epiglottis data；
Step 3 obtains Cormack-Lehane ranked data；
Step 4 will be Step 1: the data of step 2 and step 3 carry out statistical analysis；
Step 5 utilizes the data in ROC curve evaluation procedure two.
It further include obtaining for the accuracy for further increasing data processing in some preferred embodiments of the present invention
Mallampati ranked data.
It further include step 6 in some preferred embodiments of the present invention, by the Mallampati ranked data and described
The data combination processing of step 2 obtains air flue classification results.
In the step 2, other center thyroid cartilage upper limb plane thyroid cartilage is obtained to the distance between epiglottis data
Are as follows:
The distance between epiglottis is arrived by the other center thyroid cartilage upper limb plane thyroid cartilage of measurement, and the first shape is soft
The distance between bone upper limb plane thyroid cartilage and the epiglottis line are perpendicular to skin surface.
Further, the measurement thyroid cartilage upper limb plane thyroid cartilage to the distance between epiglottis be ultrasonic measurement first
Shape cartilage upper limb plane thyroid cartilage arrives the distance between epiglottis.
A kind of method for predicting difficult airway disclosed by the embodiments of the present invention, by measuring thyroid cartilage upper limb plane first shape
Cartilage arrives the distance between epiglottis, and the distance between the thyroid cartilage upper limb plane and the epiglottis line are perpendicular to skin
Skin surface；
When the distance between described thyroid cartilage upper limb plane thyroid cartilage to epiglottis is in >=8.55mm, it is judged as tired
Difficult air flue；
When the distance between described thyroid cartilage upper limb plane thyroid cartilage to epiglottis is in < 8.55mm, it is judged as normal
Air flue.
Therebetween, it is judged as slightly difficult airway.
In a preferred embodiment of the invention, as shown in Fig. 2, the measurement thyroid cartilage upper limb plane is between epiglottis
Distance includes:
Thyroid cartilage upper limb plane thyroid cartilage arrives the distance between epiglottis.
The ultrasonic measurement is to hit exactly to lose shape position (other center at left and right sides of throat, preferably middle line are to left or right through side
Open 1cm in side) ultrasonic measurement.
When ultrasonic measurement, the epiglottis is the interface of epiglottis rear air and mucous membrane.It needs to go to rest the head on by measured object
It is measured after prostrate.
1 research object of embodiment
Endotracheal intubation general anesthesia row patients undergoing elective surgery 71 is selected, the age 20~80 years old, ASA was classified I~III
Grade.Reject the special cases such as incidence and upper jaw abnormality, tumour, fracture of cervical spine.This research is suffered from through being ratified by Ethics Committee
Person or family members sign informed consent form.
2 conventional data acquisition of embodiment and air flue are assessed
Patient carries out general data acquisition, including name, gender, age, height, weight etc. between anesthesia prepares, into
Mallampati classification, the assessment of mouth opening, first chin distance and neck mobility of row improvement.
Mallampti scoring: patient firmly dehisces to loll to greatest extent, and examiner is according to the visibility of pars oralis pharyngis structure
It is classified:
1 grade, it is seen that soft palate, pharyngopalatine arch, palate hang down；
2 grades, it is seen that soft palate, pharyngopalatine arch, palate lappet point are blocked；
3 grades, rarely seen soft palate；
4 grades, have no soft palate；
3 or 4 grades it is possible that difficult intubation.
Mouth opening assessment: advising patient to dehisce as far as possible, with patient's index finger, middle finger and nameless measurement mouth opening；Normal value
>=4cm (two horizontal fingers), < 4cm is it is possible that difficult intubation.
First chin distance: the layback of patients head's maximum, the distance of measurement thyroid cartilage to mental tubercle；Normal value >=6cm ,≤
6cm prompts difficult intubation.
Neck mobility: neck does buckling to greatest extent to the scope of activities of stretching, extension；80 ° of normal value > ,≤80 ° of prompts are inserted
Pipe is difficult.
3 ultrasonic measurement of embodiment
Patient goes pillow to lie down, and is placed in other on the left of throat hit exactly with 40 12L-SC sagittal plain of GE-Healthcare Venue
(middle line is other to the left to open 1cm), measures hyoid bone and thyroid cartilage clearly as shown in Fig. 2, hitting exactly clinically by side and losing shape position
Image, it is seen that thyroid cartilage and hyoid bone, as label, visible epiglottis rear air is in mucous membrane interface below thyroid cartilage
Linear high echo, the distance of measurement skin to epiglottis, as shown in Figure 3, wherein left other sagittal plane obtains view thyrohyoid membrane
(THM).H=hyoid bone；SM=muscles,ribbon；TC=thyroid cartilage；PES=preepiglottic space；E=epiglottis；A-M=air mucous membrane
Interface.The acquisition of ultrasound data is completed by the same trained anesthetist.
The anesthesia of embodiment 4 is classified with Cormack-Lehane
Patient's conventional oxygen uptake after entering the room, open peripheral vein, monitoring blood oxygen saturation, electrocardiogram and upper limb non-invasive blood pressure.
Anesthesia induction, successively Intravenous Injection of Midazolam 2mg, 0.3~0.5 μ g/kg of sufentanil, Propofol 1.5~2mg/kg are suitable
Benzene 1.5mg/kg.The ventilation of mask pure oxygen exposes glottis with direct laryngoscope after flesh pine is complete, and parallel C ormack-Lehane divides
Grade, I, II grade is regarded as normal air flue, still III, IV grade or can not be placed in as difficult airway after oppressing outside larynx.
Cormack-Lehane is classified the criterion as difficult airway, determines that the diagnosis of various appraisal procedures is accurate
Rate, susceptibility, specificity, rate of missed diagnosis, misdiagnosis rate, positive likelihood ratio and negative likelihood.
Susceptibility=true positives ÷ (true positives+false negative) × 100%,
Specificity=true negative ÷ (true negative+false positive) × 100%,
Accuracy rate=(true positives+true negative) ÷ total number of persons × 100%,
Rate of missed diagnosis=false negative ÷ (true positives+false negative) × 100%,
Misdiagnosis rate=false positive ÷ (true negative+false positive) × 100%,
Youden index=susceptibility+specificity -1,
Positive likelihood ratio=true positives ÷ false positive,
Negative likelihood=false negative ÷ true negative.
Area under the curve and best section using Receiver operating curve (ROC curve) calculating ultrasound data index
(cut off)。
5 statistical disposition of embodiment
Statistical analysis is carried out using SPSS23.0 software package.Meet the quantitative data of normal distribution is indicated with ± s, skewness
The quantitative data of distribution is indicated with median (quartile), is carried out using two independent samples t tests between non-parametric test and group
Compare.Qualitative data indicates that the comparison of 2 kinds of methods uses the chi-square criterion of matched-pair design with rate.P < 0.05 shows that difference has statistics
Learn meaning.
6 result of embodiment
It shares 71 patients and is included in research, wherein Cormack-Lehane is classified as 15 (difficult airways of difficult intubation
Group), normal air flue 56 (normal air flue group).2 groups of each indicator differences of patient's ordinary circumstance are not statistically significant (P > 0.05).
The difference of ultrasonic measurement thyroid cartilage upper limb plane skin to epiglottis distance is statistically significant (P=0.002), as shown in table 1,
P < 0.05.
Table 1
Using the thyroid cartilage of ROC curve evaluation ultrasonic measurement to the distance of epiglottis, area is 0.860 under ROC curve
(95%CI:0.742~0.979), best section are 8.55mm；At this time accuracy rate, susceptibility, specificity be respectively 82.00%,
80.00% and 82.14%.(Mallampati classification, mouth opening, first chin distance and the neck of improvement are living with other appraisal procedures
Dynamic degree) comparison result show:
Thyroid cartilage is to the accuracy rate of epiglottis range prediction difficult airway, susceptibility, the equal highest of youden index, and rate of missed diagnosis is most
It is low；
Mallampati is classified susceptibility highest, and rate of missed diagnosis and negative likelihood are minimum, as shown in table 2.
Further Mallampati is classified and is compared with the appraisal procedure of ultrasonic measurement thyroid cartilage to epiglottis distance,
The no significant difference (P=0.170) of 2 kinds of appraisal procedure sensitivity as the result is shown, ultrasonic measurement thyroid cartilage to epiglottis
The specificity of distance is apparently higher than Mallampati classification (P=0.003), and misdiagnosis rate is smaller；And Mallampati classification
Rate of missed diagnosis is smaller, as shown in table 2.
Table 2
The present invention considers that reasons are influenced by thyroid cartilage calcification, the excessively high probe contacts of male's larynx are bad etc., hits exactly
The structure at sagittal measurement larynx position will receive limitation, so this research is other sagittal plain measurement thyroid cartilage upper limb plane skin
To the distance of epiglottis, the position at laryngoscope tip when being intubated closer to Cormack-Lehane classification with direct laryngoscope.The present invention exists
Other sagittal plain can be clearly seen that epiglottis, and can accurately be measured.Measure the best section of thyroid cartilage to epiglottis distance
(the best section in ROC curve) is 8.55mm, and the distance of ultrasonic measurement thyroid cartilage of the present invention to epiglottis is in best section
The no significant difference of susceptibility and Mallampati classification, many appraisal procedures need to measure and much refer in the prior art
Mark, very complicated simultaneously spends longer time to assess, therefore is very difficult to apply in clinical practice, if this research will
2 kinds of appraisal procedures of distance of Mallampati classification and ultrasonic measurement thyroid cartilage to epiglottis combine, and susceptibility can reach
93.33%, rate of missed diagnosis 13.33%, operation is simple, is significantly improved with a kind of predictive ability of appraisal procedure of application,
Anesthesia predicts that difficult airway reduces the generation of adverse consequences to carry out appropriate airway management in time.
In conclusion disclosed in this invention through other median sagittal position ultrasonic measurement thyroid cartilage upper limb plane skin to meeting
Difficult airway can be predicted in the distance detested, and joint Mallampati classification can improve the ability of correct identification difficult airway.
The foregoing is merely presently preferred embodiments of the present invention, practical range not for the purpose of limiting the invention；If do not taken off
It from the spirit and scope of the present invention, modifies or equivalently replaces the present invention, should all cover in the claims in the present invention
In protection scope.
Claims (5)
1. a kind of data processing method of air flue measurement characterized by comprising
Step 1 obtains the first air flue data, obtains mouth opening data, first chin data and neck mobility data；
Step 2 obtains other center thyroid cartilage upper limb plane thyroid cartilage to the distance between epiglottis data；
Step 3 obtains Cormack-Lehane ranked data；
Step 4 will be Step 1: the data of step 2 and step 3 carry out statistical analysis；
Step 5 utilizes the data in ROC curve evaluation procedure two.
2. the method according to claim 1, wherein further including obtaining Mallampati ranked data.
3. according to the method described in claim 2, it is characterized in that, further including step 6, by Mallampati classification number
Air flue classification results are obtained according to the data combination processing with the step 2.
4. the method according to claim 1, wherein obtaining other center thyroid cartilage upper limb in the step 2
Plane thyroid cartilage is to the distance between epiglottis data are as follows:
The distance between epiglottis is arrived by the other center thyroid cartilage upper limb plane thyroid cartilage of measurement, and on the thyroid cartilage
The distance between edge plane thyroid cartilage and the epiglottis line are perpendicular to skin surface.
5. the method according to claim 1, wherein the measurement thyroid cartilage upper limb plane thyroid cartilage is attended the meeting
The distance between detest and to arrive the distance between epiglottis for ultrasonic measurement thyroid cartilage upper limb plane thyroid cartilage.
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Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| WO2015173109A1 (en) * | 2014-05-14 | 2015-11-19 | Universite Pierre Et Marie Curie (Paris 6) | Method for processing images in order to determine a degree of mobility of the vocal chords |
| CN105832339A (en) * | 2016-03-31 | 2016-08-10 | 南京市第医院 | Communicator type difficult airway detection instrument |
| US20170189634A1 (en) * | 2014-05-15 | 2017-07-06 | Barrett J. Larson | System, Method, and Device For Airway Assessment and Endotracheal Intubation |
-
2019
- 2019-06-26 CN CN201910558927.XA patent/CN110313944A/en active Pending
Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| WO2015173109A1 (en) * | 2014-05-14 | 2015-11-19 | Universite Pierre Et Marie Curie (Paris 6) | Method for processing images in order to determine a degree of mobility of the vocal chords |
| US20170189634A1 (en) * | 2014-05-15 | 2017-07-06 | Barrett J. Larson | System, Method, and Device For Airway Assessment and Endotracheal Intubation |
| CN105832339A (en) * | 2016-03-31 | 2016-08-10 | 南京市第医院 | Communicator type difficult airway detection instrument |
Non-Patent Citations (2)
| Title |
|---|
| 倪红伟 等: "超声测量皮肤至会厌距离对困难气道的预测价值", 《上海交通大学学报（医学版）》 * |
| 郭玲 等: "超声在气道评估与管理中的应用进展", 《赣南医学院学报》 * |
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Application publication date: 20191011 |