在患有Pierre Robin序列征的儿童中使用可弯曲支气管镜进行气管支气管插管：并发症的护理注意事项
Tracheobronchial intubation using flexible bronchoscopy in children with Pierre Robin sequence: Nursing considerations for complications.
作者信息
Ye Ying-Long, Zhang Cai-Feng, Xu Li-Zhen, Fan Hui-Feng, Peng Jun-Zheng, Lu Gen, Hu Xiao-Yin
机构信息
Department of Respiratory Medicine, Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China.
出版信息
World J Clin Cases. 2022 Jul 6;10(19):6464-6471. doi: 10.12998/wjcc.v10.i19.6464.
BACKGROUND
It has been shown that children with Pierre Robin sequence (PRS) have a higher risk of difficult intubation before surgery. When mask ventilation or tracheobronchial intubation is expected to be challenging, flexible bronchoscopy (FB) is advantageous in airway safety when it is used to guide tracheobronchial intubation (TI).
AIM
To evaluate the complications of TI using FB in children with PRS and explore the effect of nursing services on postoperative complications.
METHODS
One hundred and five children with PRS underwent TI using FB before early mandibular distraction osteogenesis. One hundred and eight children with common pneumonia who did not have a difficult airway were set as the control group. Demographic data, success rates of TI, time required for TI, number of TI attempts, and the incidence of postoperative complications were assessed. Besides, the strategies used to attenuate complications were investigated.
RESULTS
The success rate of TI was 100% in children with PRS, while the success rate at the first attempt in the PRS group was significantly lower than that in the control group (88.6% 98.2%, = 0.005). The time required for TI in the PRS group was markedly longer than that in the control group ( < 0.001). Children in the PRS group required repetitive operations to enter the glottis successfully ( = 0.017). The incidence of complications was noticeably higher in the PRS group (50/105, 47.6%) than in the control group (36/108, 33.3%) ( = 0.034). Seven of 105 PRS children experienced laryngeal edema (LE) (6.7%), compared with one (0.9%) in the control group ( = 0.034). Out of the seven patients who had LE, all were reintubated and managed with steroids: six recovered with inhaled steroids alone before extubated, and one was given systemic corticosteroids before recovery.
CONCLUSION
FB contributes to a high success rate of TI in children with PRS. To prevent LE, operators should pay more attention to catheter material, catheter lubrication and intubation time.
背景
已有研究表明，患有皮埃尔·罗宾序列征（PRS）的儿童术前发生困难插管的风险较高。当预计面罩通气或气管支气管插管具有挑战性时，在引导气管支气管插管（TI）时，可弯曲支气管镜（FB）对气道安全具有优势。
目的
评估在患有PRS的儿童中使用FB进行TI的并发症，并探讨护理服务对术后并发症的影响。
方法
105例患有PRS的儿童在早期下颌骨牵张成骨术前使用FB进行TI。将108例无气道困难的普通肺炎儿童作为对照组。评估人口统计学数据、TI成功率、TI所需时间、TI尝试次数以及术后并发症的发生率。此外，还研究了用于减轻并发症的策略。
结果
患有PRS的儿童TI成功率为100%，而PRS组首次尝试的成功率显著低于对照组（88.6%对98.2%，P = 0.005）。PRS组TI所需时间明显长于对照组（P < 0.001）。PRS组儿童需要重复操作才能成功进入声门（P = 0.017）。PRS组并发症的发生率明显高于对照组（50/105，47.6%）（36/108，33.3%）（P = 0.034）。105例PRS儿童中有7例出现喉水肿（LE）（6.7%），而对照组中有1例（0.9%）（P = 0.034）。在这7例发生LE的患者中，所有患者均重新插管并使用类固醇治疗：6例在拔管前仅通过吸入类固醇恢复，1例在恢复前接受了全身皮质类固醇治疗。
结论
FB有助于提高患有PRS的儿童TI的成功率。为预防LE，操作人员应更加注意导管材料、导管润滑和插管时间。
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