小儿支气管插管对即时性气道峰压的影响  

Influence of pediatric endobronchial intubation on immediate peak inflation pressure

作　　者：冯国辉[1] 王姝媛[1] 陈继荣[1] 张秋金[1] 

机构地区：[1]解放军白求恩国际和平医院,石家庄050082

出　　处：《北京军区医药》2001年第3期164-165,共2页

摘　　要：目的 探讨支气管插管（EBI）是否能引起即时性气道峰压（PIP）升高及观察其升高的数值。方法 对16例长期应用抗生素治疗而需要手术的骨髓炎患儿,常规术前给药和麻醉诱导后（氧气中混合氟烷）行气管插管（ETI））。用听诊法和荧光检查法确定导管位置,以5L流量新鲜气体,用预设容积的定压式呼吸机行机械通气。全部患儿用相似的环路、气管导管、压缩容积行恒定的潮气量呼吸。按15 ml/kg潮气量使用最低PIP,调整呼吸频率和麻醉水平后,记录气管插管的PIP。使气管导管移至支气管,用上述方法确定位置,然后记录PIP,随后将气管导管拔回至气管。结果 支气管PIP明显比气管PIP高（P<0.001）,支气管PIP升高是即时性的。结论 支气管插管可引起即时性PIP升高,气管插管时和麻醉期间监测PIP有助于发现EBI的发生。Objective To determine whether endobronchial intubation (EBI) always causes an immediate increase in peak inflation pressure (PIP) and to meassure the magnitude of the increase. Methods The study group inluded sixteen children with osteomyelitis being scheduled for surgical operation because of poor response to prolonged antibitotic administration. After routine premedication and induction of anesthesia(halothane in oxygen) were finished, an endotrachealtube was inserted and its postition was verified by auscultation and fluoroscopy. On a preset volume-pressure-limit ventilator with 5L fresh gas flow, the children were mechanically ventilated. They all received a constant tibal volume with a simialar circuit, similar tubing, and similar compression volume. The lowest peak inflation pressure(PIP) was applied to maintain a tidal volume of 15 ml/kg. After adjusting the respiratory rate (Pet CO2 30 mmHg) and anesthetic level (halothane end-tidal 1. 2%), we recorded the peak inflation preassure at this endotracheal position. And then the endotracheal tube was advanced into the bronchus, and the postition was verified in the way described above. Aflerwards, the peak inflalion pressure was recorded again. The endobronchial tube was then pulled back into the trachea. Results The peak inflation pressure at the endobronchial position was significantly greater than that at the endoctracheal postition(P<0. 001). This increase was instantaneous at the endobtrchial position. Conclusions Endobronchial intubation could producean instanta-meous increase in PIP. Monitoring peak inflatin pressure while inserting endotracheal tube and during anesthesia was help-full in diagnosing endobronchial tintubation.

关 键 词：气管内插管法 气道峰压 儿童 外科手术 

分 类 号：R726.1[医药卫生—儿科]