自制抗折压型气管导管延长管用于脑瘫患儿俯卧位手术的气道管理

摘要

Objective To investigate the effect and safety of a self-made endotracheal extension tube against kinking or collapsing for airway management in children with cerebral palsy surgery in prone position. Methods Twenty five children with cerebral palsy ASA Ⅰor Ⅱof both sexes, aged 2-12 yr with weighing 10-46 kg undergoing functionality selective posterior rhizoto-my (FSPR)were used the volume control ventilation (VCV) after induction and tracheal intubation. The self-control experiment was employed for research. The blood pressure, SpO 2 , P ET CO 2 , airway peak pressure (P peak ) and airway plat pressure(P peak ) were recorded after 10minutes of mechanical ventilation, and radial artery blood was collected to analyzing of bedside blood gas.Then the self-made extension tube was joined between the endotracheal tube and Y tube. The same monitoring was actualized after 10minutes on the premise of not changing the parameters of ventilation. Results The oxygenations in children of two kinds of airway management are satisfied and the hemodynamic is stable before and after increasing the extension tube. There were no statistically sig-nificant differences of P plat、P peak、SpO 2、PaO 2、P ET CO 2 ,PaCO 2 (P > 0. 05). It overcomes the disadvantages of less lip exposed part and not natural spin after increasing the extension tube. Conclusion The self-made endotracheal extension tube against kinking or collapsing is simple and easy to do, does not increase in airway resistance, can be safely used in general anesthesia for airway man-agement in children with cerebral palsy surgery in prone position.%目的：探讨自制抗折压型气管导管延长管用于脑瘫患儿俯卧位下手术气道管理的效果和安全性。方法拟行功能性选择性脊神经后根切断术的脑瘫患儿25例,ASAⅠ~Ⅱ级,性别不限,年龄2~12岁,体重10~46kg。麻醉诱导插管后采用容量控制(VCV)通气。采用自身对照实脸,机械通气10min 后记录血压、SpO 2、P Et CO 2、气道压力峰值(P peak )、平台压(P plat ),采集桡动脉血作床旁血气分析。然后在气管导管与 Y 形接头之间加上自制的抗折压型气管导管延长管,不改变通气参数,10min 再进行同样的监测并记录。结果2种气道管理方式患儿的氧合都满意,增加延长管前后患儿血流动力学稳定,Pplat、Ppeak、Sp02、Pa02、P ET CO 2,PaCO 2等差异无统计学意义(P >0.05)。增加延长管后克服了导管口唇外露部分较少而与螺纹管连接后不能自然旋置的缺点。结论自制抗折压型气管导管延长管简单易做,不增加患儿气道阻力,可安全用于全麻下行脑瘫患儿俯卧位下手术的气道管理。