Fine Gavin F, Borland Lawrence M
Department of Anesthesiology, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
Paediatr Anaesth. 2004 Jan;14(1):38-42. doi: 10.1046/j.1460-9592.2003.01203.x.
It has been traditionally taught that only uncuffed endotracheal tubes (ETTs) should be used for intubation in children younger than 8, or even 10, years old. However, recent literature suggests that the advantages of using uncuffed ETTs in children may be just another myth of paediatric anaesthesia. Using an uncuffed ETT does allow a tube of larger internal diameter to be used, minimizing resistance to airflow and the work of breathing in the patient who is breathing spontaneously. However, this advantage does not hold for ventilated patients, for whom ventilator settings can be adjusted to provide optimal airflow. Longer duration of intubation and a poorly fitted ETT are risk factors for mucosal damage, whether the ETT is cuffed or uncuffed. Furthermore, a properly sized, positioned, and inflated modern (low-pressure, high-volume) cuffed ETT can offer many advantages over an uncuffed ETT, including greater ease of intubation, better control of air leakage, lower rate and better control of flow of anaesthetic gases, and decreased risk of aspiration and infection.
传统观念认为，对于8岁甚至10岁以下的儿童进行气管插管时应仅使用无套囊气管内导管（ETT）。然而，最近的文献表明，在儿童中使用无套囊ETT的优势可能只是小儿麻醉的又一个误区。使用无套囊ETT确实可以使用内径更大的导管，从而将自主呼吸患者的气流阻力和呼吸功降至最低。然而，对于机械通气的患者，这一优势并不成立，因为可以调整呼吸机设置以提供最佳气流。无论ETT有无套囊，插管时间延长和ETT适配不佳都是黏膜损伤的危险因素。此外，尺寸合适、位置正确且充气适当的现代（低压、大容量）带套囊ETT相比无套囊ETT具有许多优势，包括插管更容易、漏气控制更好、麻醉气体流速更低且控制更好，以及误吸和感染风险降低。
