小儿光导纤维支气管镜引导三步气管插管技术的临床评估

Clinical Assessment of Fiberoptic Bronchoscope-Guided Three-Stage Intubation Technique in Children

目的评价小儿光导纤维支气管镜（FOB）引导三步气管插管技术的可操作性和临床应用价值。方法收治美国麻醉医师协会（ASA）Ⅰ级,年龄4～13岁,拟施择期外科手术患儿10例。常规静脉麻醉诱导,通过ID为5.5mm的成人型FOB引导将ID为7.0mm的较粗气管导管顶在声门口,小心退出FOB（第1步）;在人工通气证实气管导管是位于喉口后,经较粗气管导管向气管内插入一根合适的可通气性气管导管交换芯（VETC）,沿VETC退出较粗的气管导管（第2步）。然后沿VETC将润滑良好且直径合适的细气管导管插入气管内（第3步）。记录整个气管插管操作所需的时间和操作中遇到的困难及其采取的辅助措施,手术后随访有无呼吸道并发症发生。结果本组患儿10例FOB引导三步气管插管成功100%。在沿VETC推送气管导管时,虽然2例小儿因润滑不满意和VETC外径不合适出现了沿VETC推送气管导管困难的情况,经过相应的处理措施均被有效解决。完成气管插管所需的时间为（124.1±15.2）s。所有患者手术后随访未发现呼吸道并发症。结论在小儿,FOB引导三步气管插管技术具有操作简单、成功率高的优点,该方法可有效解决无法将成人型粗直径FOB应用于小儿困难呼吸道处理的临床难题。

Objective To assess the clinical value of the fiberoptic bronchoscope （FOB） - guided three - stage intubation technique in children and observe its maneuverability and clinical validity. Methods Ten pediatric patients, American Society of Anesthesiologists （ASA） grade Ⅰ ,aged 4 - 13 years old and scheduled for selective surgery ,were included in this study. After the routine intravenous induction of anesthesia,a thicker endotracheal tube with an ID of 7.0 mm was advanced into the laryngeal aperture using an adult version FOB with an ID of 5.5 mm,and then the FOB was carefully withdrawn through the thicker endotracheal tube （one -stage）. After the correct endotracheal tube placement at the laryngeal aperture was confirmed, a suitable ventilating endotracheal tube changer （VETC） was inserted into the trachea through the thicker endotracheal tube, after which the thicker endotracheal tube was withdrawn along the VETC （ two - stage ）. A well - lubricated thinner endotracheal tube that was suitable for each child was inserted into the trachea along the VETC （ three - stage）. The time required for the intubation, and the difficulties encountered and the auxiliary maneuvers adopted during the manipulation were recorded. A post- operative follow - up for each patient was done to evaluate whether the airway complications occurred. Results The success rate of the FOB - guided three - stage intubation technique was 100%. The difficulty to advance the endotracheal tube over the VETC due to inadequate lubrication and inappropriate external diameter of the VETC was observed in 2 patients, but was effectively corrected by the corresponding measures. The time required for the intubation was （ 124.1 ± 15.2 ） s. The postoperative follow - up showed no any airway complication in all patients. Conclusions The FOB - guided three - stage intubation technique in pediatric patients has the advantages of simple manipulation and high success rate. It can effectively solve the clinical difficult problem that the adult version thick FOB is impossible to be used in pediatric difficult airway management.