自塑形导管插管对婴幼儿颅缝早闭Cor、E、NA水平的影响

Effect of self⁃shaping catheter intubation on levels of Cor,E and NA in infants with prema⁃ture closure of cranial suture

目的探讨自塑形导管插管对婴幼儿颅缝早闭皮质醇(Cor)、肾上腺素(E)和去甲肾上腺素(NA)水平的影响。方法依据随机数字表法将2020年12月至2021年12月南京医科大学附属儿童医院收治的76例全麻下行颅缝早闭手术患儿分为对照组(38例)和观察组(38例),对照组采用插管钳辅助插管,观察组则采用自塑形导管插管。记录两组插管相关指标、喉镜暴露分级及在诱导后(T_(0))、声门暴露时(T_(1))、插管后1 min(T_(2))、插管后3 min(T_(3))时平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)变化情况;比较两组血清Cor、E、NA变化水平。结果观察组插管时间短于对照组,首次插管成功率则高于对照组,差异有统计学意义(P<0.05)。两组喉镜暴露分级比较,差异无统计学意义(P>0.05)。T_(0)~T_(3)两组患儿HR、MAP均呈先升高后降低趋势,其中T_(2)时刻观察组HR、MAP低于对照组,差异有统计学意义(P<0.05)。和T0相比,两组T_(3)血清Cor、E和NA水平均升高,观察组低于对照组,差异有统计学意义(P<0.05)。结论相较于插管钳辅助插管,自塑形导管插管能够缩短颅缝早闭婴儿插管时间,提高首次插管的成功率,且患儿的生命体征相对更加平稳,应激反应相对更低。

Objective To explore the effect of self⁃shaping catheter intubation on the levels of cor⁃tisol(Cor),epinephrine(E)and norepinephrine(NA)in infants with premature closure of cranial suture.Methods According to the random number table,76 cases of children undergoing craniosynostomy under gen⁃eral anesthesia at the Children's Hospital Affiliated to Nanjing Medical University from December 2020 to De⁃cember 2021 were divided into the control group(38 cases)and the observation group(38 cases).The control group was intubated with intubation forceps,while the observation group was intubated with self⁃shaping cath⁃eter.The intubation⁃related indexes,laryngoscope exposure classification,and the changes of ean arterial pres⁃sure(MAP),heart rate(HR),blood oxygen saturation(SpO_(2))m after induction(T_(0)),glottis exposure(T_(1)),1 min after intubation(T_(2))and 3 min after intubation(T_(3))were recorded in both groups.Changes in serum Cor,E and NA in the two groups were also measured.Results The intubation time in the observation group was shorter than that in the control group,and the success rate of the first intubation was higher than that in the con⁃trol group,with statistical significance(P<0.05).There was no significant difference between the two groups(P>0.05).The HR and MAP of the children in T_(0)~T_(3) groups increased and then decreased.At T_(2),the HR and MAP in the observation group were lower than those in the control group,with statistical significance(P<0.05).Compared to T0,the levels of serum Cor,E and NA in in both groups increased by T_(3),but the levels in the observation group were lower than those in the control group,with statistical significance(P<0.05).Conclusion Compared to the intubation assisted by intubation forceps,using a self⁃shaping catheter for nasotracheal intubation in infants with premature closure of cranial sutures can shorten the intubation time,increase the success rate of the first intubation,and result in relatively stable vital signs for the children.Additionally,this method can help lower the stress response in these infants.