超声快速判断困难气道患者气管导管误入食管的可靠性

Reliability of ultrasound for rapid identification of esophageal intubation in patients with difficult airway

目的评价超声快速判断困难气道患者气管导管误入食管的可靠性。方法择期行经口气管插管全身麻醉患者21例，年龄20-75岁，体重指数25～32kg／m2，ASA分级I或Ⅱ级，直接喉镜下Cormack—Lehane分级Ⅲ或Ⅳ级。麻醉诱导前使用超声在胸骨上切迹处扫描并识别颈动脉、气管和食管。麻醉诱导后行气管插管的同时利用超声观察，判断气管导管是否误入食管。气管插管完成后，行机械通气，听诊双肺呼吸音，然后通过PETCO2监测再次判断气管导管是否误人食管。结果超声判断困难气道患者气管导管误入食管的灵敏度和特异度均为100％。结论超声可快速、准确地判断困难气道患者气管导管误入食管。

Objective To evaluate the reliability of ultrasound for rapid identification of esophageal intubation in the patients with difficult airway. Methods Twenty-one patients requiring orotraeheal intuba- tion, aged 20-75 yr, with body mass index of 25-32 kg/m2, of ASA physical status Ⅰ or Ⅱ , Cormack- Lehane grade Ⅲ or Ⅳ under direct laryngoscope, undergoing elective general anesthesia, were selected. The carotid artery, trachea and esophagus were identified by ultrasonic scanning at suprasternal notch before induction of anesthesia. After induction of anesthesia, tracheal intubation was performed. During intubation, ultrasound was performed to detect esophageal intubation. After intubation, mechanical ventilation was per- formed. Auscultation of bilateral breath sounds was carried out to evaluate the tube position. The position of the tube was subsequently determined through partial pressure of end-tidal CO2 monitoring. Results The sensitivity and specificity of ultrasound in identifying esophageal intubation were both 100% in the patients with difficult airway. Conclusion Ultrasound can rapidly and effectively identify esophageal intubation in the patients with difficult airway.