超声法确定新生儿气管插管位置的准确性  

Accuracy of ultrasound in verifying endotracheal tube position in neonates

作　　者：章艳君[1] 徐魏军 刘金柱[1] 袁志浩[1] Zhang Yanjun;Xu Weijun;Liu Jinzhu;Yuan Zhihao(Department of Anesthesiology and Ultrasound, Tianjin Children′s Hospital, Tianjin 300074, China;Department of Anesthesiology and Ultrasound, Tianjin Children′s Hospital, Tianjin 300074, China)

机构地区：[1]天津市儿童医院麻醉科,300074 [2]天津市儿童医院超声科,300074

出　　处：《中华麻醉学杂志》2018年第10期1238-1240,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价超声法确定新生儿气管插管位置的准确性。方法全身麻醉行脐尿管瘘/脐尿管切除术或腹股沟疝修补术的新生儿60例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄2~28d,体重2.5~4.8kg,采用随机数字表法分为2组(n=30):听诊组和超声组。分两阶段判断气管导管位置:第一阶段,气管插管术后分别应用听诊法和超声法判断气管导管是否误入食管,PETCO2作为判断气管导管是否误入食管的金标准;第二阶段,确认气管导管位于气管内后,分别应用听诊法和超声法判断气管导管是否存在支气管插管,用电子支气管镜作为判断是否存在支气管插管的金标准。结果与听诊组比较,超声组判断是否存在支气管插管的准确率高(P<0.05)。听诊法判断新生儿气管导管是否存在食管内插管的灵敏度为100%、特异度为96.3%、阳性预测值为75%和阴性预测值为100%;判断是否存在支气管插管的灵敏度为33.3%、特异度为95.8%、阳性预测值为66.7%和阴性预测值为85.2%。超声法判断气管导管是否存在食管内插管或支气管插管的灵敏度、特异度、阳性预测值和阴性预测值均为100%。结论超声法可准确确定新生儿气管导管位置。Objective To evaluate the accuracy of ultrasound in verifying endotracheal tube (ETT) position in neonates. Methods Sixty neonates of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , aged 2-28 days, weighing 2.5-4.8 kg, scheduled for urachal fistula/urachal resection or inguinal hernia repair under general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: auscultation group and ultrasound group.Confirmation of ETT position was performed in two stages.In the first stage, misplacement of ETT into esophagus was identified using auscultation and ultrasound techniques after intubation, and end-tidal carbon dioxide pressure was considered as the gold standard for identification of esophageal intubation.In the second stage, misplacement of ETT into bronchus was identified using auscultation and ultrasound after confirming ETT position was within the trachea, and electronic bronchoscope served as the gold standard for identification of bronchial intubation. Results Compared with auscultation group, the accurate rate of identification of bronchial intubation was significantly increased in ultrasound group (P<0.05). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of auscultation for identification of esophageal intubation was 100%, 96.3%, 75% and 100%, respectively.The sensitivity, specificity, PPV and NPV of auscultation for identification of bronchial intubation was 33.3%, 95.8%, 66.7% and 85.2%, respectively.The sensitivity, specificity, PPV and NPV of ultrasound for identification of esophageal or bronchial intubation were all 100%. Conclusion Ultrasound can verify ETT position accurately in neonates.

关 键 词：超声检查 插管法 气管内 婴儿 新生 

分 类 号：R726.1[医药卫生—儿科]