气管导管内径大小对小儿鼾症患者术中肺通气功能的影响

Effects of different internal diameters of endotracheal tubes on the pulmonary ventilation function of children with snoring disease during surgery

目的探讨小儿鼾症手术中不同气管导管内径对肺通气功能的影响。方法选择气管插管全身麻醉行支撑喉镜下扁桃体和腺样体切除术的患儿100例,采用随机数字表法分为较小组[气管导管内径=(年龄/4+3.5)mm,S组,33例]、适当组[气管导管内径=(年龄/4+4.0)mm,A组,28例]、较大组[气管导管内径=(年龄/4+4.5)mm,L组,29例]。全身麻醉机械通气后,分别监测3组术中呼吸动力学指标:气道峰压(peak airway pressure,Ppeak)、气道平台压(plateau airway pressure,Pplat)、肺顺应性(pulmonary compliance,C)、一秒用力呼气量(forced expiratory volume in one second,FEV1)与用力肺活量(forced vital capacity,FVC)的比值[一秒率(FEV1/FVC,FEV1%)]。结果S组Ppeak和Pplat分别为(16.8±2.8)cmH2O(1 cmH2O=0.098 kPa)和(13.6±3.1)cmH2O,均高于A组和L组(P<0.05),A组和L组比较差异无统计学意义(P>0.05);S组FEV1%为(77±5)%,均低于A组[(80±3)%]和L组[(82±5)%](P<0.05),A组和L组比较差异无统计学意义(P>0.05);3组间C差异无统计学意义(P>0.05)。结论小儿鼾症手术中选择较小气管导管会引起更高的Ppeak和Pplat,降低FEV1%,影响肺通气功能。

Objective To explore the effects of different internal diameters of endotracheal tubes on the pulmonary ventilation function of children with snoring disease during surgery.Methods One hundred children with snoring disease scheduled for adenoidectomy and tonsillectomy under general anesthesia with tracheal intubation were selected and divided into three groups,according to a random number table:a small diameter group[internal diameter(ID)=(ages/4+3.5)mm,group S,n=33],an appropriate group[ID=(ages/4+4.0)mm,group A,n=28],and a large diameter group[ID=(ages/4+4.5)mm,group L,n=29].After mechanical ventilation under general anesthesia,the following respiratory parameters in the three groups were monitored during surgery:peak airway pressure(Ppeak),plateau airway pressure(Pplat),pulmonary compliance(C),forced expiratory volume in one second(FEV1)and forced vital capacity(FVC)ratio(FEV1%).Results Ppeak,and Pplat in group S were(16.8±2.8)cmH2O(1 cmH2O=0.098 kPa)and(13.6±3.1)cmH2O,respectively,which were significantly higher than those in groups A and L(P<0.05).Ppeak,and Pplat were not significantly changed between groups A and L.FEV1%in group S was(77±5)%which was significantly lower than that in groups A[(80±3)%]and L[(82±5)%](P<0.05).FEV1%was not significantly changed between groups A and L.Compliance was not significantly different among these groups.Conclusions Small endotracheal tubes can increase Ppeak and Pplat,and reduce FEV1%,with negative effects on pulmonary ventilation function for children with snoring disease during surgery.