超声测定的环状软骨横径与小儿最适加强型气管导管外径的相关性分析

Correlation between the cricoid cartilage transverse diameter measured by ultrasonography and the optimal outer diameter of reinforced endotracheal tube for children

关键词:  超声  环状软骨横径  小儿  加强型气管导管

Key words:  ultrasonography  cricoid cartilage transverse diameter  children  reinforced endotracheal tube

摘要:

目的 探讨超声测定的环状软骨横径与小儿最适加强型气管导管外径的相关性，为预测小儿加强型气管导管的型号提供指导。方法 选择1~6岁择期行外科手术的患儿120例，记录患儿的年龄、体重，在麻醉诱导后插管前应用超声技术扫描环状软骨，测量并记录最小横径DC。根据测定的环状软骨横径选择加强型气管导并插管，随后进行漏气试验判断导管是否合适并调整，记录最适加强型气管导管外径为OD。应用线性回归和相关性检验对数据进行分析，采用Bland-Altman法分析OD与DC的一致性，记录插管后气管导管的更换情况。结果 患儿的年龄、体重、DC与OD均存在相关性（P<0.01），其中DC与OD相关性最强（r=0.895），回归方程为：Y=1.02+0.85X，r²=0.795；OD与DC配对数据偏倚的均数d=0.10 mm，偏倚的标准差Sd=0.35 mm，95%一致性界限为（-0.59 mm，0.79 mm）；120例患儿均根据环状软骨横径选择的加强型气管导管，其中9例患儿气管导管偏小，5例患儿气管导管偏大，106例导管适宜，无需更换导管，一次插管成功率为88.3%。结论 超声测定的环状软骨横径可作为小儿气管插管时选择加强型气管导管型号的可靠依据。

Abstract:

Objective To investigate the correlation between the cricoid cartilage transverse diameter measured by ultrasonography and the optimal outer diameter of reinforced endotracheal tube (RETT) for children, so that the RETT model used for children may be predicted. Methods A total of 120 children aged 1 to 6 years who underwent surgery were included. Their age and weight were recorded.After anesthesia induction, ultrasonic scanning of cricoid cartilage was performed before intubation, so as to measure and record the minimal cricoid cartilage transverse diameter DC. The RETT was selected based on DC, and then a leak test was carried out. The RETT was adjusted as necessary, and the optimal outer diameter of RETT was recorded as OD. Linear regression analysis and correlation test were conducted on the data, and the consistency of OD and DC was analyzed by Bland-Altman method. The replacement of RETT after intubation was recorded. Results The age, body weight, and DC (cricoid cartilage transverse diameter) were correlated with OD (the optimal outer diameter of RETT) for all of the children (P<0.01), while the DC had the most correlation with OD (r=0.895). The regression equation was Y=1.02+0.85X, r²=0.795.For the paired data bias of OD and DC, the mean value was d=0.10 mm with standard deviation Sd=0.35mm and 95% consistency limit (-0.59 mm, 0.79 mm). For all of the 120 children, the RETTs selected according to DC were small for 9 cases and large for 5 cases, while appropriate for the other 106 cases, and the success rate of one intubation was 88.3%. Conclusion The RETT model used for endotracheal intubation of children can be reliably selected based on the cricoid cartilage transverse diameter measured by ultrasonography.