比较研究气管导管套囊不同充气方法对导管套囊压与气管黏膜损伤的影响.pdf

重庆医学2014年8月第43卷第22期
论著?临床研究doi:10.3969/j.isn.167-8348.,2014.22.011
比较研究气管导管套囊不同充气方法对导管套囊压与
气管黏膜损伤的影响
赵邦术,刘新伟
(重庆医科大学附属第一医院麻醉科,重庆400016)
摘要:目的观察气管导管套淾不同充气方法对导管套彙压与气管黏膜损伤的影响。方法选择择期全身麻醉下行妇科
肿寤切除术患者120例,随机分为3组,分别用指感法、测压法、最小封压力法给气管导管套童充气,用专用套量测压表分别测
定3种方法给气管导管套克气后的套就压カ。术半在患者苏醒找出气管导管过程中,用可视纤维喉镜观察患者气管黏膜的改
变,比较不同充气方法的导管套量压力与气管黏膜损伤的差异。结果指感法组平均套压(49土11.8cmH2O)明显高于测压
法銀(27士1.5cmH2O和最小封闭压力法组(25士2.1cmH2O),测压法和最小封闭压力法两组间平均压比较差异无统计学
意义(P>0,05)。指感法组气管黏膜损伤发生率(87.5%)較测压法组(20.0%)和最小封闭压カ法组(15.0%)明显升高,测压法
和最小封闭压力法两组间患者气管黏膜损伤的发生率比较差异无统计学意义(P>0.05)。结论凭经验用指感法给导管彙充
气,易使奁内压力远高于正常允许值,发生气管黏膜损伤风险高。米用测压法或最小封闭压力法给导管套充气,套量压力基
本控制在正常允许值范国内,2种方法均可降低患者气管黏腹损伤风险。
关键词;套淾压力;气管黏膜;气管内,插管法
中图分类号:R331
文献标识码:A
文章编号:1671-8348(2014)22-2862-03
The effect of endotracheal catheter cuff inflation method on cuff pressure and tracheal mucosal damage
2dA1れe
Department of Anaesthesia, the First Affiliated Hos pital of Chongqing Medical University, Chongqing 400016, China)
Abstract: Objective To investigate the effect of diferent methods of endotracheal catheter cuff inflation on cuff pressure and
tracheal mucosal damage postoperatively Methods 120 patients undergoing gynecological tumorectomy as a selective operation
with general anesthesia were randomly divided into 3 groups with different methods of cuff inflation: finger kneading method, sp
cialized cuff pressure meter, and minimum closing volume method. The cuff pressure were measured by specialized cuff pressure
gauge and the tracheal mucous memnbrane was examined by fibrolaryngoscope at the time of withdrawal of endotracheal tube. The
cuff pressure and the tracheal mucosal change with different cuff inflation methods were compared. Results The average cuff pres
sure with finger kneading method (49+11.8 cm H O)was obviously higher than specialized cuff pressure meter group(271.5 cm
H2 O)and minimum closing volume method group(25+
cidence
tracheal mucosa
higher in the group with finger kneading method(87.5%) than other groups(200% and 15.0% respectively). There were no obvi
ous differences in the incidence of tracheal mucosal damage between the rest two groups(P>0. 05). Conclusion The cuff pressure
in the finger kneading method was higher than the permitted value and it make the incidence of tracheal mucosal damage increase
The cuff inflation with specialized cuff pressure meter and minimum closing volume method can make the cuff pressure properly a
mong the permitted value and decrease the complications related to endotracheal intubation.
Key words cuff pressure; tracheal mucous membrane;intratracheal, intubation
在全身麻醉诱导插管时,通常需要将气管导管套囊充气封1资料与方法
闭气道以维持机械通气。套囊充气不足,机械通气漏气,潮气1
般资料选择择期全身麻醉下行妇科肿瘤手术患者
量下降,通气不足,甚至有发生误吸风险。套囊充气过多,套囊120例,采用随机、单官研究。将120例患者随机分为3组,每
压力过大,易造成气管黏膜损伤,导致气管插管后相关并发症组40例,全身麻醉诱导插管后分别予相应的套衰充气方法给
增加。临床上大多数情况下都是凭麻醉医师的临床经验为全导管套囊充气:(1)指感法;(2)测压法;(3)最小封闭压力法。
身麻醉插管患者气管导臂套囊充气,不同的麻醉医师为气管导所有患者均经口插管,气管导管套囊均为高容低压套囊。纳人
管套囊充气方法多不相同,导致气管导管套囊压力差别较大。标准:(1)年龄18~70岁;(2)体质量指数(BMI)19~30kg
套囊压力大小决定套囊是否会损伤气管黏膜的重要因素。m2;(3)美国麻醉医师协会(ASA)分级为工级或Ⅱ级;(4)带管
因此,选择合适的套囊充气方法,维持合适的套囊压力,减少全时间120~180min。(5)自愿参加本研究并签订知情同意书。
身麻醉气管插管患者气管黏膜损伤,在临床上具有重要意义。排除标准:1)近期有土呼吸道感染或肺部感染者;(2)哮喘患
本研究通过比较气管导管套囊不同充气方法的套囊压力和气者;(3)一次插管未成功或插管困难患者;(4)有咽喉部手术或
管黏膜损伤的差异,进一步明确气管导管套囊不同充气方法的外伤史患者;(5)合并咳嗽、睏喉部疼痛不适患者;(6)气腹手术
安全性,为临床选择合适的导管套囊