- 期刊
小兒全身麻醉氣管內管大小的選擇－馬偕紀念醫院之回溯性報告
A Proper Size of Endotracheal Tube for Infant and Young Child - A Retrospective Study in Mackay Memorial Hospital
摘要
背景：馬偕醫院的小兒外科手術每年超過兩千例，這些手術多半是在插管全身麻醉下進行，因此為小兒病患選擇一隻適當大小的氣管內管是每日小兒麻醉業務上的一個重要課題。方法：在全身麻醉與完全肌肉鬆弛下，選擇一隻沒有氣囊的氣管內管（uncuffed endotracheal tube, UCETT），能夠平順且無明顯阻力地插入氣管，內徑（internal diameter, ID）範圍從2.5至6.5毫米（millimeter, mm）。如果在插管過程遇到明顯的阻力，就以小一號的氣管內管再重新插管。插管完成後，再測試氣體外洩是否過度。本報告回顧馬偕醫院近六年所有小兒常規手術的麻醉記錄，在排除體重超過三十公斤以上且年齡在八歲半以上的病例後，共收錄6476例，分析不同體重（6406例）及年齡（6476例）族群的氣管內管大小的分佈，並與西方文獻的建議比較。結果：發現：（1）隨著年齡增長和體重增加，小孩的UCETT也隨之加大；（2）小孩的UCETT不論以年齡或體重來觀察均有相當大的分佈範圍，且基本上呈類似常態分佈（normal distribution）；（3）兩歲及兩歲以上的偶數歲數病例，其最常用（most frequently used size, MFUS）的UCETT內徑可用公式（18+ age in years）÷4或MFUS的外週圍（outer circumference, OC；單位為French unit, Fr）等於19+ age in years來表示（僅適用兩歲到八歲偶數歲數的小孩）；（4）不論以年齡或體重分析，MFUS加上比MFUS的ID大0.5 mm及小0.5 mm的UCETT，所佔的百分比均相差不多（94.65%比94.76%），這也表示除了最常用的三隻氣管內管之外，仍有必要準備其他大小的氣管內管。結論：不管用何種方法來預測小孩氣管內管的大小，至少需再各準備一條大一號及一條小一號的氣管內管，以助於看到聲門後，能迅速地選擇適當大小的氣管內管。由於只有約95%的小孩適用MFUS加上比MFUS的ID大0.5 mm及小0.5 mm這三種大小的UCETT，所以我們也建議在小兒麻醉峙，仍應準備其他各種不同大小的氣管內管，以備不時之需。
並列摘要
Background: There are more than 2000 pediatric patients receiving surgery in Mackay Memorial Hospital each year. Most of these surgery were performed under general anesthesia with endotracheal tube; therefore choosing an appropriate size of endotracheal tube becomes an important issue in our daily practice. Methods: Our principle is to choose an uncuffed Mallinckrodt endotracheal tube with a proper internal diameter (ID), ranging from 2.5 mm to 6.5 mm, which could be suitably and gently inserted into the trachea under full muscle relaxation. The tube would then be immediately removed and replaced with a smaller one if facing obvious resistance during intubation. After intubation, a leak test was applied to ascertain that there was no excessive gas leakage. We reviewed all anesthetic records of elective pediatric surgery in the recent 6 years, and the patients whose age above 8.5 years old and body weight (Wt) above 30 kg were excluded from this study. Using age (6476 cases) and Wt (6406 cases) as our parameters, we analyzed these data according to the distribution of each size of uncuffed endotracheal tube (UCETT) in different age and Wt intervals and compared them with the recommended Western reports. Results: Our results revealed that (1) the UCETT size increases as age or Wt increases; (2) considerable spread of UCETT sizes for different age and Wt intervals and basically represent as normal distribution; (3) for the case of even age equal or above 2 years old (up to 8 years old), the ID of the most frequently used UCETT can be memorized as (18 + age in years) ÷ 4 or the outer circumference (OC) of the Mallinckrodt UCETT (in French unit, Fr) = 19 + age in years; and (4) Wt as a parameter for tube size selection was as powerful as age (94.76% vs. 94.65%). Conclusions: From our results, we concluded that ＂whatever method of predicting tube size is used, tracheal tubes 0.5 mm larger and smaller should be available at the time of intubation so that the proper size can be chosen when the glottis is visualized.＂