最低有效气管导管套囊压用于女性患者气管插管全麻腹腔镜手术的临床研究.pdf

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Guungxi Medical Journal, Feb 2015, Vol 37, No. 2
论?临床研究
最低有效气管导管套囊压用于女性
患者气管插管全麻腹腔鏡手术的临床研究
谭宗池黄山鉴2谢新美劳贵昌“谢寒冰”陈梅颜韦良鹏张兴
(广西医科大学第十附属医院暨饮州市第一人民医院1麻醉科,2药剂科,
3普外科,4骨科,5耳鼻喉科,6肿瘤科,钦州市535099,E-mail:2669515725のq,com)
【摘要】目的观察最低有效套囊压用于气管插管全麻腹腔镜手术的临床效果及安全性。方法择期行气管插管全麻
腹腔镜手术的女性患者60例,按随机数字表法分为对照纽和试验组,各30例,对照组应用手指感觉法给气管导管套囊充气
试验组应用最低有效套囊压法给套充气。记录两组患者套压;术毕拔除气管导管时行纤维支气管镋检查,观察气管黏膜
损伤情况;记录拔除气管导管后套貮有无血迹及拔管后24h内咽喉疼和声音嘶哑等气管插管相关并发症的发生情况。结
果试验组患者套隶压为(9.07±5.38)cmH20,明显低于对照组的(32.40±5.16)cemH20(P<0.05);两组患者拔除气管导管
后均未发生套貮血迹和声音嘶哑;两组患者拔除气管导管后24h内咽喉疼痛发生率比较,差异无统计学意义(P>0.05);试验
组气管黏膜散在点状充血发生率明显高于对照组(P<0.05),但局部片状充血发生率明显低于对照组(P<0.05)。结论最
低有效气管导管套曩压用于气管插管全麻腹腔镋手术的女性患者临床效果好,对气管黏膜损伤小。
【关键词)气管内插管;全身麻醉;最低有效气管导管套囊压;腹胶镜;女性
中图分类号】R614.2(文献标识码】B[文章编号)0253-4304(2015)02-0178-04
DOI:10.11675/j.iss.0253-4304.2015.02.14
Clinical study of minimum effective tracheal cuff pressure applied to
laparoscopic surgery with general anesthesia and tracheal intubation in female patients
TA Zong-chi A hnn XE X - i A Guhgeha-ing Chenmei-yan, WI eng, ZHANG Xin
(tDepartmnentofAnesthesiodogy,2DepoameatdfPhamnory,3DepormentofGenerdSaurgery,DAepurtmenofonthopedics,sDepeortmnentofoorhinolarnmgology,
6DeurtmneuggfoOneology,theFisilPeople'sHlospialrfQinholCiny,heTenthAfiliaedaspitalfeaanegailMedianlUininersiy,Qinzboun53509,China)
Abstract Objective To observe the clinical effect and safety of minimum effective tracheal cuff pressure applied to laparoscopic
surgery with general anesthesia and tracheal intubation. Methods Sixty female patients undergoing selective laparoscopic surgery with
general anesthesia and tracheal intubation were randomly divided into control gru and experimental group, with 30 cases in each group
Finger feeling method was op o uf aon in e conrol ru, while the method of minimum e ective cuff pressure was adopted to
cuff inflation in the exper menta gou. The cuff pressure of patients was recorded in two groups, bronchofiberscopy was performed following
tracheal extubation after operation, e nc ne f acheal mucosa injury was served, and the incidence of ff lood after tracheal extubation
ell as the incidences of racheal intuation-assoc ate mplications including throat pain and hoarseness within 24 hours after
extubation was recorded. Results The experimental group gained a lower cuff pressure compared with the control group([9.07+ 5.38
cmh, us 32. 405. 16]cmh, 0, P<0.05) No cuff blood and hoarseness cases occurred in two groups, and no significant difference was
found in the incidence of throat pain within 4 hours after racheal extubation between two ous(P>. 05). The experimental group owned
a significantly higher incidence of scattered petechial hyperemia in tracheal mucosa and a significantly lower incidence of local schistose
hyperm a ompared with the ontrol group(P<0. 05 Conclusion The minimum effectie raceal cuff pressure applied to laparoscopi
surgery with general anesthesia and tracheal intubation achieves better effects and less damages to tracheal mueosa in female patients
Key words] Endotracheal intubation; General anesthesia; Minimum effective tracheal cuff pressure; Laparoscope; Female
气管插管全麻手术患者气管导管套襄充气不足可验给气管导管套囊充气,已不再常规监测套囊压。在英
致漏气,影响通气效果,甚至导致误吸口腔分泌物或胃国部分医院ICU内,监测气管导管套囊压的气管插管病
内返流物;套囊压力过高可影响气管黏膜血液灌注,导人比例仅为13%~25%21。然而大量研究证实凭经验
致局部缺血,甚至诱发溃疡、出血及坏死,严重者可导致给气管导管套囊充气并不可靠。一