胸片对小儿气管插管指导作用.docVIP

胸片对小儿气管插管指导作用[摘要] 目的 观察应用胸片指导小儿气管插管时导管大小及插管深度预测的效果。方法 采用单盲法，对ASAI～III级，拟在插管全麻下行择期或急诊手术治疗的小儿外科或骨科患儿70例分别应用胸片及公式法对气管导管大小及插管深度进行预测，与临床实际插管大小及深度相比，观察胸片预测、公式预测与临床实际插管的符合率。结果 62例患者进入实验组；胸片在导管型号预测时符合率达66.1%（公式的符合率为66.3%），在导管深度预测时符合率为88.7%（公式的符合率为79%）。结论 小儿发育个体性强，国人活体小儿气管内径及长度流行性研究不多。与常规公式计算方法相比，小儿胸片可同样有效地为临床插管时小儿气管导管直径大小及插管深度提供参考。 [关键词]X-Ray； 气管插管； 小儿 [中图分类号] R322.3+3[文献标识码] B[文章编号] 1005-0515（2011）-02-068-02 The effect direction of Chest X radiated chest X to catheter choosing in pediatric intubations [Abstract] Objective To observe the guiding role of chest radiograph for sides and depth of tube with pediatric intubations. MethodsPatients who were schedule or emergency in pediatric surgery (ASAI-III) were involved in the study by the single-blind way (n=70) under general anaesthesia. The size and depth of pediatric intubations was predicted by chest radiograph or formula respectively. Compared with the actual size of the endotracheal tube and the actual depth of intubations in clinical medicine, the conformity rate of the prediction of chest radiograph and the conformity rate of the formula prediction were observed. Results62 patients are involved in the experimental group. The conformity rate of the type prediction of the endotracheal tube of chest radiograph is 66.1% while the conformity rate of the formula prediction is 66.3%. In the prediction of the depth of intubations, the conformity rate of chest radiograph is 88.7% while the conformity rate of the formula prediction is 79%. Conclusion The report of the chest radiograph might be the one guidelines just like formula to predicted the size of the endotracheal tube and the depth of intubations for reference. [Keywords]X-Ray; Intubations; Pediatric 随着医疗技术及仪器设备的发展与进步，麻醉相关并发症与死亡率已明显降低，在小儿危重病例抢救、心肺复苏抢救及近来暴发的手足口病等疾病治疗中，有部分小儿需行气管插管有时是必要的治疗手段之一，其中选用合适的气管导管、插入适当的深度对随后的呼吸管理有重要意义［1］。由于小儿头面、颈部解剖特点，不同的年龄及体格发育使气管小儿气的大小及长度差异较大，与成人相比，小儿气管插管风险更大[2]道和呼吸管理有一定困难及风险，根据小儿的年龄及体格发育选用合适的气管导管是重要的手段与方法。临床上常遇到小儿气管插管过浅，导致气管脱出；或