小儿气管插管过深评价指标的比较  

Comparison of parameters for evaluating endobronchial intubation in pediatric anesthesia

作　　者：李春华[1] 陈锡明[2] 

机构地区：[1]复旦大学附属儿科医院麻醉科,上海201102 [2]上海交通大学医学院附属新华医院麻醉科

出　　处：《上海医学》2011年第6期438-440,共3页Shanghai Medical Journal

摘　　要：目的通过双肺呼吸音听诊、目测胸廓活动度、监测气道压力和呼吸系统顺应性的变化判断气管导管是否进入支气管内过深,并比较上述评价指标判断小儿麻醉中气管插管过深的可靠性。方法择期行全身麻醉手术的患儿50例,气管插管后先用纤维支气管镜测量门齿至隆突的距离,再缓慢将气管导管深置,每进入5 mm听诊双肺呼吸音,观察胸廓活动度,监测气道压力和呼吸系统顺应性的变化。结果监测气道压力和呼吸系统顺应性判断支气管内插管的正确率为100%(50/50),根据呼吸音听诊和观察胸廓活动度判断支气管内插管的正确率分别为54%(27/50)和24%(12/50)。当气管插管深入支气管内,气道压力由主气管内的(14.4±3.8)cmH2O(1 cmH2O=0.098 kPa)升高至(17.8±4.0)cmH2O(P<0.01),平均升高幅度为(25.7±13.3)%;呼吸系统顺应性由主气管内的(20.3±9.9)mL/cmH2O下降至(12.2±6.9)mL/cmH2O(P<0.01),平均下降幅度为(41.5±12.2)%。气道压力与呼吸系统顺应性变化幅度的差异有统计学意义(P<0.01)。结论小儿麻醉期间,监测气道压力和呼吸系统顺应性是判断气管导管插入过深的灵敏方法。Objective To evaluate the existance of endobronchial intubation using auscultation of bilateral breath sounds,observation of thorax movement changes,airway pressures and respiratory compliance,and to compare the reliability of the above method for evaluating the presence of endobronchial intubation in pediatric patients.Methods Fifty children（ASA Ⅰ-Ⅱ） aged 8 months-11 years,weighing 8-57 kg,undergoing selected surgery,were intubated.A fiberoptic examination was performed to record the distance from incisors to carina.Auscultation of bilateral breath sounds,observations of thorax movement changes,airway pressures and respiratory pulmonary compliance were recorded as the endotracheal tube was advanced in a 5mm increment.Results Monitoring of airway pressures and respiratory compliance achieved a 100%（50/50） correct rate in evaluating tracheal intubation;auscultation of bilateral breath sounds and observation of thorax movement change achieved a 54%（27/50） and 24%（12/50）,respectively.Endobronchial intubation increased airway pressure from（14.4±3.8） cmH2O（1 cmH2O=0.098 kPa） to（17.8±4.0） cmH2O（P0.01）,with a mean increase of（25.7±13.3）%;it also decreased respiratory compliance from（20.3±9.9） mL/cmH2O to（12.2±6.9） mL/cmH2O（P0.01）,with a mean decrease of（41.5±12.2）%.Conclusion Monitoring of airway pressure and respiratory system compliance is sensitive in detecting endobronchial intubation during pediatric anesthesia.

关 键 词：支气管内插管 肺顺应性 气道压力 听诊 小儿麻醉 

分 类 号：R726.1[医药卫生—儿科]