超声在阻塞性睡眠呼吸暂停综合征患儿气管插管中的应用  

Application of airway ultrasound in surgical tracheal intubation in children with obstructive sleep apnea-hypopnea syndrome

作　　者：刘慧慧[1] 黄彦逵 刘洁 蔡清香[1] 马武华[1] LIU Huihui;HUANG Yankui;LIU Jie;CAI Qingxiang;MA Wuhua(Department of Anesthesiology,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一附属医院麻醉科,510405

出　　处：《临床麻醉学杂志》2022年第9期926-929,共4页Journal of Clinical Anesthesiology

基　　金：广州市科技计划项目(201707010297)。

摘　　要：目的探讨超声在阻塞性睡眠呼吸暂停综合征(OSAS)患儿气管插管时选择合适导管型号、插管成功率、围术期气道相关并发症中的应用效果。方法选择择期全麻下行扁桃体和(或)腺样体切除术的OSAS患儿123例,男59例,女64例,年龄3~8岁,身高92~141 cm,体重16~39 kg,ASAⅠ或Ⅱ级,MallampatiⅠ或Ⅱ级。采用随机数字表法将患儿分为两组:超声组(n=62)和常规组(n=61)。超声组通过测量环状软骨内空气-黏膜界面直径来选择导管型号,听诊法和气管超声检查定位导管深度;常规组采用年龄公式确定气管导管型号,听诊法确定插管深度。记录插管深度、首次插管成功例数、插管时间和气管导管置换、气管导管脱出、支气管内插管、咳嗽声嘶、拔管后喘鸣等围术期气道相关并发症发生情况。结果与常规组比较,超声组插管深度明显增加(P<0.05),首次插管成功率明显升高(P<0.05),插管时间明显延长(P<0.05),气管导管置换发生率明显降低(P<0.05)。两组气管套管脱出、支气管内插管、咳嗽声嘶和拔管后喘鸣发生率差异无统计学意义。结论OSAS患儿术中通过气管超声选择气管导管型号及定位导管深度,可有效地保证导管位置,精准插管深度,提高首次插管成功率,降低围术期气道相关并发症发生率。Objective To investigate the effect of airway ultrasonography in selecting appropriate catheter type,success rate of intubation,and reducing perioperative airway complications in children with obstructive sleep apnea-hypopnea syndrome(OSAS).Methods A total of 123 OSAS children with tonsillectomy and/or adenoidectomy surgery under elective general anesthesia were selected,59 males and 64 females,aged 3-8 years,heighting 92-141 cm,weighing 16-39 kg,ASA physical statusⅠorⅡ,Mallampati gradeⅠorⅡ,were divided into two groups by random number table method:ultrasound group(n=62)and routine group(n=61).In ultrasound group,the type of catheter was selected by measuring the diameter of the air-mucosal interface in the cricoid cartilage,and the depth of the catheter was determined by auscultation and airway ultrasonography.The model and depth of endotracheal tube were determined by age formula and auscultation in routine group.Intubation depth and number of successful intubation at first time,intubation time,airway complications and adverse events such as endotracheal tube replacement,tracheal tube prolapse,endobronchial intubation,hoarseness of cough and wheezing after extubation were recorded.Results Compared with the routine group,the depth of intubation and the success rate of first time intubation were significantly increased(P<0.05),the time of intubation was significantly prolonged(P<0.05),and the incidence of endotracheal tube replacement was significantly decreased in the ultrasound group(P<0.05).There were no significant differences in tracheal tube prolapse,endobronchial intubation,hoarseness of cough and wheezing after extubation between the two groups.Conclusion Children with OSAS can select the tracheal catheter type and locate the depth of the catheter by tracheal ultrasound,which can effectively ensure the location of the catheter,achieve accurate intubation depth,improve the success rate of the first intubation,and reduce the incidence of perioperative airway-related complications.

关 键 词：超声 阻塞性睡眠呼吸暂停综合征 儿童 气管插管 插管深度 

分 类 号：R445.1[医药卫生—影像医学与核医学] R766[医药卫生—诊断学]