超声测量环状软骨水平气道横径用于小儿带套囊气管导管的选择
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摘要
目的:探讨超声测量环状软骨水平气道横径(MTDSA)用于小儿带套囊气管导管选择的临床效果。方法:选择4～12岁行择期全身麻醉手术需气管插管的患儿共180例,通过年龄公式经验性选择气管导管型号,插管后根据漏气试验确定气管导管型号,同时在麻醉诱导气管插管前应用超声测量MTDSA。针对选择导管型号合适的病例,分别对MTDSA、年龄、身高、体质量与临床最适导管内径(ID)之间进行相关统计学分析并建立MTDSA与ID之间的线性回归方程,再分别对超声测量法与年龄公式法选择导管的准确率进行临床验证和分析。结果:与其他因素相比,MTDSA与导管ID之间的相关性更好,超声测量法确定的线性回归方程为ID=0.601×MTDSA+0.015(r=0.954),超声测量法与年龄公式法的准确率分别为80%和46%,差异有统计学意义(χ~2=12.40,P<0.05)。结论:超声测量MTDSA可以作为一种准确简便的方法用于指导小儿带套囊气管导管的选择。
Objective:To evaluate the clinical effects of the MTDSA measured by ultrasound in selecting the cuffed pediatric endotracheal tube size.Methods:The tracheal tube sizes in 180 pediatric patients,aged 4 to 12 years,scheduled by general anesthesia operation were empirically selected according to the age based formula.The appropriate tracheal catheter type was determined according to the leakage gas test after intubation,and MTDSA was measured using ultrasound before anesthesia induction endotracheal intubation.The correlation of MTDSA,age,height and body mass with clinical optimal catheter inner diameter(ID) in cases with suitable catheter was analyzed,and the linear regression equation of which was established.The accuracy of catheter selected by ultrasound and age based formula was validated and analyzed in clinic.Results:Compared with other factors,MTDSA was well correlated with catheter ID.The linear regression equation determined by ultrasound was established for ID=0.601 xMTDSA+0.015(r=0.954).The accuracy rates of ultrasound and age based formula were 80% and 60%,respectively,and the difference of which was statistically significant(χ~2=12.40,P<0.05).Conclusions:MTDSA measured by ultrasound is an accurate and simple method in guiding the selection of cuffed tracheal tube size in children.
Objective:To evaluate the clinical effects of the MTDSA measured by ultrasound in selecting the cuffed pediatric endotracheal tube size.Methods:The tracheal tube sizes in 180 pediatric patients,aged 4 to 12 years,scheduled by general anesthesia operation were empirically selected according to the age based formula.The appropriate tracheal catheter type was determined according to the leakage gas test after intubation,and MTDSA was measured using ultrasound before anesthesia induction endotracheal intubation.The correlation of MTDSA,age,height and body mass with clinical optimal catheter inner diameter(ID) in cases with suitable catheter was analyzed,and the linear regression equation of which was established.The accuracy of catheter selected by ultrasound and age based formula was validated and analyzed in clinic.Results:Compared with other factors,MTDSA was well correlated with catheter ID.The linear regression equation determined by ultrasound was established for ID=0.601 xMTDSA+0.015(r=0.954).The accuracy rates of ultrasound and age based formula were 80% and 60%,respectively,and the difference of which was statistically significant(χ~2=12.40,P<0.05).Conclusions:MTDSA measured by ultrasound is an accurate and simple method in guiding the selection of cuffed tracheal tube size in children.
引文
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[10] ALTUN D,ORHAN-SUNGUR M,ALI A,et al.The role of ultrasound in appropriate endotracheal tube size selection in pediatric patients[J].Paediatr Anaesth,2017,27(10):1015.
[11] KRISHNA SG,HAKIM M,SEBASTIAN R,et al.Cuffed endotracheal tubes in children:the effect of the size of the cuffed endotracheal tube on intracuff pressure[J].Paediatr Anaesth,2017,27(5):494.
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[13] 苏相飞,彭书崚,杜素娟,等.超声测定小儿环状软骨横径用于带套囊气管导管型号选择的准确性[J].中华麻醉学杂志,2017,37(7):784.
[14] 李倩,张正迪,蔡铁良.超声测量声门下气道横径用于小儿无囊气管导管的选择[J].国际麻醉学与复苏杂志,2017,38(8):714.
[2] SHIH MH,CHUNG CY,SU BC,et al.Accuracy of a new body length based formula for predicting tracheal tube size in Chinese children[J].Chang Gung Med Journal,2008,31(3):276.
[3] NEWTH CJ,RACHMAN B,PATEL N,et al.The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care[J].J Pediatr,2004,144(3):333.
[4] HUSEIN M,MANOUKIAN JJ,PLATT R,et al.Ultrasonography and videobronchoscopy to assess the subglottic diameter in the paediatric population:a first look[J].J Otolaryngol,2002,31(4):220.
[5] LITMAN RS,WEISSEND EE,SHIBATA D,et al.Developmental changes of laryngeal dimensions in unparalyzed,sedated children[J].Anesthesiology,2003,98(1):41.
[6] FAYOUR P,DEVISME L,MERROT O,et al.Determination of endo-tracheal tube size in a perinatal population:an anatomical and experimental study[J].J Anesthesiology,2006,104(5):954.
[7] TOBIAS JD.Pediatric airway anatomy may not be what thought:implications for clinical practice and the use of cuffed endotracheal tubes[J].Paediatr Anaesth,2015,25(1):9.
[8] GNANAPRAKASAM PV,V SELVARA J.Ultrasound assessment of subglottic region for estimation of appropriate endotracheal tube size in pediatric anesthesia[J].J Anaesthesiol Clin Pharmacol,2017,33(2):231.
[9] SUTAGATTI JG,RAJA R,KURDI MS.Ultrasonographic estimation of endotracheal tube size in paediatric patients and its comparison with physical indices based formulae:A prospective study[J].J Clin Diagn Res,2017,11(5):C5.
[10] ALTUN D,ORHAN-SUNGUR M,ALI A,et al.The role of ultrasound in appropriate endotracheal tube size selection in pediatric patients[J].Paediatr Anaesth,2017,27(10):1015.
[11] KRISHNA SG,HAKIM M,SEBASTIAN R,et al.Cuffed endotracheal tubes in children:the effect of the size of the cuffed endotracheal tube on intracuff pressure[J].Paediatr Anaesth,2017,27(5):494.
[12] CHO AR,KIM ES,LEE DW,et al.Comparisons of recursive partitioning analysis and conventional methods for selection of uncuffed endotracheal tubes for pediatric patients[J].Paediatr Anaesth,2015,25(7):698.
[13] 苏相飞,彭书崚,杜素娟,等.超声测定小儿环状软骨横径用于带套囊气管导管型号选择的准确性[J].中华麻醉学杂志,2017,37(7):784.
[14] 李倩,张正迪,蔡铁良.超声测量声门下气道横径用于小儿无囊气管导管的选择[J].国际麻醉学与复苏杂志,2017,38(8):714.