Fayoux Pierre, Devisme Louise, Merrot Olivier, Marciniak Bruno
Service d'Oto-Rhino-Laryngologie (ORL) et Chirurgie CervicoFaciale-Hôpital Huriez, Centre Hospitalier Regional Universitaire (CHRU) Lille, France.
Anesthesiology. 2006 May;104(5):954-60. doi: 10.1097/00000542-200605000-00011.
This study aimed at correlating anatomical dimensions of the larynx and trachea to age and weight in a prenatal population. Endotracheal tube size determination was then proposed according to these considerations.
Anatomical measurements were obtained during 150 fetal and infant postmortem examinations. The optimal endotracheal tube size was determined by three methods: clinically, by a pressure method using calibrated inextensible balloons, and anatomically by comparing the laryngotracheal perimeter to the tube perimeters. Based on these results, recommended tube sizes were calculated.
In premature babies before 37 weeks gestation, the optimal tube size according to pressure estimation was significantly greater than that determined by anatomical measurement alone. This difference was no longer valid after 40 weeks gestation.
This study identified the elasticity of laryngeal structures in premature babies, allowing intubation with tube sizes greater than predicted by anatomical measurements with an increasing injury risk located in the posterior part of the glottic plane. This elasticity disappears near 40 weeks gestation, and the injury risk then predominates in the subglottic region. These results lead the authors to recommend that the size of the endotracheal tube used in the perinatal population should be based on anatomical and experimental data to limit the injury risks.
本研究旨在探讨产前人群中喉和气管的解剖学尺寸与年龄及体重之间的相关性，并据此提出气管内导管尺寸的确定方法。
在150例胎儿及婴儿尸检过程中进行解剖学测量。通过三种方法确定最佳气管内导管尺寸：临床方法、使用校准的不可伸展气囊的压力法以及通过比较喉气管周长与导管周长的解剖学方法。基于这些结果，计算推荐的导管尺寸。
在妊娠37周前的早产儿中，根据压力估计的最佳导管尺寸显著大于仅通过解剖学测量确定的尺寸。妊娠40周后，这种差异不再存在。
本研究发现早产儿喉结构具有弹性，使得使用大于解剖学测量预测尺寸的导管进行插管成为可能，但声门平面后部的损伤风险增加。这种弹性在妊娠40周左右消失，此时损伤风险主要集中在声门下区域。这些结果促使作者建议，围产期人群使用的气管内导管尺寸应基于解剖学和实验数据，以降低损伤风险。
