Kohjitani Atsushi, Iwase Yoko, Sugiyama Kazuna
Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan.
Paediatr Anaesth. 2008 Sep;18(9):845-51. doi: 10.1111/j.1460-9592.2008.02668.x.
Appropriate sizes (internal diameters) and insertion depths of uncuffed preformed endotracheal tubes in children with cleft lip and palate, who generally have delayed growth and development in early infancy have not been elucidated.
The sizes and insertion depths of endotracheal tubes in patients who received primary cheiloplasty and/or palatoplasty in relation to age, height, and weight were retrospectively analyzed. Tube sizes were determined using an appropriate air leakage at an airway pressure of 15-20 cmH2O. Tube insertion depths were confirmed by auscultation of bilateral breathing sounds at several tube depths, placing the tip 1.5 cm above the carina. Obtained data sets were compared with previously published studies.
The number of cases analyzed was 236 in total. The mean age, height, and weight were 327.4 +/- 199.2 days, 69.7 +/- 7.5 cm, and 8.2 +/- 1.8 kg, respectively (mean +/- SD). Neither the tube size nor tube depth in cleft lip and palate children was smaller or shorter than those of normal subjects. Discrepancies between the preformed bend and the tube insertion depth increased as the tube size increased.
The current findings suggest that it is reasonable to apply the currently available standards for normal children, e.g. Motoyama's general guide, to predict the tube size and insertion depth for Japanese cleft lip and palate children, and that the use of the uncuffed preformed endotracheal tube is associated with a risk of endobronchial intubation, which appears to increase with age.
唇腭裂患儿通常在婴儿早期生长发育迟缓，目前尚未明确无套囊预制气管导管的合适尺寸（内径）和插入深度。
回顾性分析接受一期唇成形术和/或腭裂修复术患者的气管导管尺寸和插入深度与年龄、身高和体重的关系。通过在气道压力为15 - 20 cmH₂O时适当的漏气来确定导管尺寸。通过在几个导管深度听诊双侧呼吸音来确认导管插入深度，使导管尖端位于隆突上方1.5 cm处。将获得的数据集与先前发表的研究进行比较。
总共分析了236例病例。平均年龄、身高和体重分别为327.4 ± 199.2天、69.7 ± 7.5 cm和8.2 ± 1.8 kg（平均值 ± 标准差）。唇腭裂患儿的导管尺寸和深度均不小于或短于正常受试者。随着导管尺寸的增加，预制弯曲与导管插入深度之间的差异增大。
目前的研究结果表明，应用目前适用于正常儿童的标准（如本多山的一般指南）来预测日本唇腭裂患儿的导管尺寸和插入深度是合理的，并且使用无套囊预制气管导管存在支气管内插管的风险，这种风险似乎随着年龄的增长而增加。
