Blayney M P, Logan D R
Department of Neonatology, Queen's University, Kingston General Hospital, Ontario, Canada.
Arch Dis Child Fetal Neonatal Ed. 1994 Jul;71(1):F32-5. doi: 10.1136/fn.71.1.f32.
After intubation in newborn infants, the placement of the endotracheal tube in the trachea must be checked by a chest radiograph. The most commonly used reference point for placement is the medial ends of the clavicles. The position of the clavicles may be variable. The present study was carried out to determine whether the body of the first thoracic vertebra should be used instead of the clavicles because its position on chest radiographs is more constant. Seventy eight radiographs obtained from 35 neonates were examined prospectively. The carina was situated between T3 and T5, most commonly at T3-4 or T4 (85%). The position of the clavicles varied markedly from patient to patient and within the same patient on different days, and this variation was significantly higher than that of the carina. On 65 (83%) examinations the clavicles lay above the first thoracic vertebra. It is recommended that, for accurate placement within the trachea, the tip of the endotracheal tube should be placed at the level of the body of the first thoracic vertebra; this could be used as the sole reference point on chest radiographs obtained in the neonatal period.
新生儿插管后，必须通过胸部X线片检查气管内导管在气管内的位置。最常用的位置参考点是锁骨内侧端。锁骨的位置可能会有所不同。本研究旨在确定是否应使用第一胸椎椎体代替锁骨，因为其在胸部X线片上的位置更恒定。对从35例新生儿获得的78张X线片进行了前瞻性检查。隆突位于T3和T5之间，最常见于T3 - 4或T4（85%）。不同患者之间以及同一患者在不同日期锁骨的位置差异明显，且这种差异显著高于隆突的差异。在65次（83%）检查中，锁骨位于第一胸椎椎体上方。建议为准确放置在气管内，气管内导管尖端应放置在第一胸椎椎体水平；这可作为新生儿期获得的胸部X线片上的唯一参考点。
