Khine H H, Corddry D H, Kettrick R G, Martin T M, McCloskey J J, Rose J B, Theroux M C, Zagnoev M
duPont Hospital for Children, Wilmington, Delaware 19899, USA.
Anesthesiology. 1997 Mar;86(3):627-31; discussion 27A. doi: 10.1097/00000542-199703000-00015.
Uncuffed endotracheal tubes are routinely used in young children. This study tests a formula for selecting appropriately sized cuffed endotracheal tubes and compares the use of cuffed versus uncuffed endotracheal tubes for patients whose lungs are mechanically ventilated during anesthesia.
Full-term newborns and children (n = 488) through 8 yr of age who required general anesthesia and tracheal intubation were assigned randomly to receive either a cuffed tube sized by a new formula [size(mm internal diameter) = (age/4) + 3], or an uncuffed tube sized by the modified Cole's formula [size(mm internal diameter) = (age/4) + 4]. The number of intubations required to achieve an appropriately sized tube, the need to use more than 21.min-1 fresh gas flow, the concentration of nitrous oxide in the operating room, and the incidence of croup were compared.
Cuffed tubes selected by our formula were appropriate for 99% of patients. Uncuffed tubes selected by Cole's formula were appropriate for 77% of patients (P < 0.001). The lungs of patients with cuffed tubes were adequately ventilated with 2 1.min-1 fresh gas flow, whereas 11% of those with uncuffed tubes needed greater fresh gas flow (P < 0.001). Ambient nitrous oxide concentration exceeded 25 parts per million in 37% of cases with uncuffed tubes and in 0% of cases with cuffed tubes (P < 0.001). Three patients in each group were treated for croup symptoms (1.2% cuffed; 1.3% uncuffed).
Our formula for cuffed tube selection is appropriate for young children. Advantages of cuffed endotracheal tubes include avoidance of repeated laryngoscopy, use of low fresh gas flow, and reduction of the concentration of anesthetics detectable in the operating room. We conclude that cuffed endotracheal tubes may be used routinely during controlled ventilation in full-term newborns and children during anesthesia.
无套囊气管内导管常用于幼儿。本研究测试了一种选择合适尺寸套囊气管内导管的公式，并比较了套囊与无套囊气管内导管在麻醉期间机械通气患者中的使用情况。
将需要全身麻醉和气管插管的足月新生儿及8岁以下儿童（n = 488）随机分配，分别接受根据新公式[内径尺寸（mm）=（年龄/4）+ 3]选择的套囊导管，或根据改良科尔公式[内径尺寸（mm）=（年龄/4）+ 4]选择的无套囊导管。比较为获得合适尺寸导管所需的插管次数、使用超过2 L·min⁻¹新鲜气流的必要性、手术室中氧化亚氮的浓度以及喉炎的发生率。
根据我们的公式选择的套囊导管适用于99%的患者。根据科尔公式选择的无套囊导管适用于77%的患者（P < 0.001）。使用2 L·min⁻¹新鲜气流时，套囊导管患者的肺部通气充分，而11%的无套囊导管患者需要更大的新鲜气流（P < 0.001）。无套囊导管的病例中，37%的手术室环境氧化亚氮浓度超过百万分之二十五，而套囊导管的病例中这一比例为0%（P < 0.001）。每组有3例患者接受了喉炎症状治疗（套囊导管组1.2%；无套囊导管组1.3%）。
我们的套囊导管选择公式适用于幼儿。套囊气管内导管的优点包括避免重复喉镜检查、使用低新鲜气流以及降低手术室中可检测到的麻醉剂浓度。我们得出结论，在足月新生儿和儿童麻醉期间的控制通气中，可常规使用套囊气管内导管。
