Lopez Merrick R, Abd-Allah Shamel, Deming Douglas D, Piantini Rebeca, Young-Snodgrass Amy, Perkin Ronald, Barcega Besh, Sheridan-Matney Clare
From the Divisions of *Pediatric Critical Care, †Neonatology, ‡Forensic Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA; §Department of Pediatrics, East Carolina University, Greenville, NC; and ∥Division of Pediatric Emergency Medicine, Loma Linda University Children's Hospital, Loma Linda, CA.
Pediatr Emerg Care. 2014 May;30(5):305-10. doi: 10.1097/PEC.0000000000000124.
The objective of this study was to identify the incidence of oral, jaw, and neck injury secondary to endotracheal intubation in young children.
This prospective observational study was conducted in the pediatric intensive care unit at a level 1 trauma center. From October 1998 to January 1999 and November 2007 to April 2008, all intubated patients younger than 3 years with no prior oral procedures were examined within 24 hours of intubation. A standardized form was used to record injuries. Separately, medical records were reviewed for prior injuries. Chi-square/Fisher exact test was used for statistical analysis.
Of 105 patients included in the study, 12 had oral, jaw, or neck injury. One patient had a hard palate injury from a pen cap in his mouth during a seizure. Another broke a tooth biting the laryngoscope blade (the only injury directly attributable to intubation). The remaining 10 patients were determined to be those who experienced abusive trauma. The overall incidence of injury directly from intubation was 0.9%. Oral, jaw, and neck injuries were all significantly associated with abusive trauma (P < 0.001). Eleven patients had difficult intubations: 9 had no injuries, 1 experienced abusive trauma and the second was the patient who broke his tooth during intubation.
Oral, jaw, or neck injury in young children is rarely caused by endotracheal intubation, regardless of difficulty during the procedure.
本研究的目的是确定幼儿气管插管后继发口腔、颌面部和颈部损伤的发生率。
这项前瞻性观察性研究在一家一级创伤中心的儿科重症监护病房进行。在1998年10月至1999年1月以及2007年11月至2008年4月期间，对所有年龄小于3岁且此前未进行过口腔手术的插管患者在插管后24小时内进行检查。使用标准化表格记录损伤情况。另外，查阅病历以了解既往损伤情况。采用卡方检验/费舍尔精确检验进行统计分析。
在纳入研究的105例患者中，有12例发生了口腔、颌面部或颈部损伤。1例患者在癫痫发作时口中含笔帽导致硬腭损伤。另1例患者咬喉镜叶片时折断一颗牙齿（这是唯一直接归因于插管的损伤）。其余10例患者被确定为遭受虐待性创伤。插管直接导致的损伤总发生率为0.9%。口腔、颌面部和颈部损伤均与虐待性创伤显著相关（P<0.001）。11例患者插管困难：9例未受伤，1例遭受虐待性创伤，另1例是插管时折断牙齿的患者。
幼儿口腔、颌面部或颈部损伤很少由气管插管引起，无论插管过程中是否困难。
