介绍一种新的气管内插管最佳深度的定位方法(附200例分析)

A NEW METHOD FOR OPTIMIZING THE TUBE LENGTH IN THE TRACHEA DURING ENDOTRACHEAL INTUBATION (ANALYSIS OF 200 CASES)

以往气管内插管的定位方法虽多,但都不够确切和全面,有一定的盲目性,因此插管过深或过浅时有发生。本文介绍一种新定位方法:以手指在胸骨上窝触摸气管,当插管尖端通过时可清楚触及,如掌握得当则可获得插管的最佳深度。本文通过200例测量与观察发现,此定位方法有一定规律性,如气管中点位于胸骨上窝,插管最佳深度与身高有很好的相关性,并总结推导出简便计算公式。

Endotracheal intubation (ETI) is an essential technique in general anesthesia and resuscitation. Although a number of methods for optimizing the tube length in the trachea have been introduced in the literature, too deep or too shallow intubation does happen frequently. The authors developed a new method to identify exactly the optimal endotracheal tube length during ETI, by which the tip of the endotracheal tube (ETT) can be palpated at the suprasternal fossa when it passes down and is finally located just 1 cm below the suprasternal fossa.Chest X-ray of 200 cases was studied before the operation. It was found that 90% of the superior margin of the manubrium were at the level of vertebra T_3, only 10% at T_2, and the tracheal carina of most cases was at T_5. The suprasternal fossa was just at the midpoint of the trachea and the position of the tip of ETT located 1 cm below it should be optimal. Following the guidance of our method, the post-operative X-ray of these cases showed that 91% of the tips of ETT were located at T3 and T2. The optimal length of ETT is closly related to body height in all ages (r=0.967), and to age in children (r=0.936). The authors suggest that the optimal tube length (cm) can also be calculated by adding the length from the nostril to the ipsilateral ear-lobe, the length from the Adam's apple to the suprasternal fossa and 2.