The Clinical Observation of Difficult Laryngoscopy and Intubation in Children with Cleft Lip and Palate<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /> 佟世义 薛富善 邓晓明 张雁鸣 廖 旭 刘建华 唐耿志 中国医学科学院中国协和医科大学整形外科医院麻醉科,北京100041 Shiyi Tong, Fushan Xue, Xiaoming Deng, Yanming Zhang , Xu Liao, Jianhua Liu, Gengzhi Tang Department of Anesthesiology,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical college,Beijing 100041. ABSTRACT Objective: To evaluate the incidence of difficult laryngoscopy in children with cleft lip and palate and to explore the relationships of it with children's age and difficult intubation. Methods: 985 paediatric patients, aged 0~3years, undergoing repair of cleft lip and palate were divided into three groups according to the age: 0~6m, 6~12m and 1~3y. Laryngoscopic views were estimated by classification of Cormack and Lehane, GradeⅠ~Ⅱ as easy laryngoscopy and grade Ⅲ~Ⅳ as difficult laryngoscopy. The easy, uneasy, or difficult intubation manipulations were evaluated by the number of attempt. Results: The total incidence of difficult laryngoscopy was 4.776% in children with cleft lip and palate. There was a significant association between age and the incidence of difficult laryngoscopy(P<0.05). The incidence of difficult laryngoscopy was 7.06%, 2.99% and 3.13% in the children of 0~6m, 6~12m and 1~3y, respectively. The incidence of uneasy and difficult intubation were 1.02% and 0.91%, respectively. The total incidence of intubation failure was 0.102%. Children with the difficult laryngoscopy had higher possibility of difficult intubation. The incidence of intubation failure was 2.13% in children with the difficult laryngoscopy. Conclusions: Children with cleft lip and palate have a hight incident of difficult laryngoscopy. There was a significant association between children's age and the incidence of difficult laryngoscopy. The difficult intubation occurred mainly in the children with laryngoscopic views of grade Ⅲ~Ⅳ. Key words: Laryngoscopy; Cleft Lip and Palate; Children; Difficult Intubation Corresonding author: Fushan Xue, MD; E-mail address: Xuebai@fescomail.net *本研究为中国医学科学院整形外科医院基金资助项目,编号:200307 本临床研究的目的是观察唇腭裂小儿喉镜显露困难的发生率,并探讨其与小儿年龄和气管插管操作难易度的关系。 资料与方法 一般资料 选择中国医学科学院整形外科医院1998年~2002年间985例ASA Ⅰ~Ⅱ级拟在全身麻醉下施唇腭裂修复术的婴幼儿,年龄在22天~3岁,体重3.5~18kg,男678例,女307例。其中唇裂531例;腭裂426例;唇裂继发畸形15例。根据年龄将小儿分为0~6m、6~12m和1~3y三个年龄组。 麻醉方法 手术前0.5h肌内注射阿托品0.01~0.01mg•kg-1或东莨菪碱0.01mg•kg-1。患儿进入手术室后以2.5%氟烷(或3%安氟烷或2.5%异氟烷)和60%氧化亚氮进行吸入麻醉诱导,患儿意识消失后建立静脉通路,静脉注射丙泊酚1.5~2mg•kg-1和琥珀胆碱1~1.5mg•kg-1或维库溴铵0.1~0.12mg•kg-1进行麻醉诱导,待肌肉松弛满意后进行直接喉镜显露和气管插管操作。 |