拔管后喉喘鸣的危险因素分析及气囊漏气试验的临床意义
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摘要
目的评估拔管后喉喘鸣的危险因素,探讨气囊漏气试验的临床意义。方法选取某院住院的气管插管患者共311例,分析拔管后喉喘鸣的危险因素;拔管前进行气囊漏气试验。结果共311例患者,其中21例患者拔管后出现喉喘鸣,拔管后喉喘鸣的Logistic回归分析显示女性,气管插管时间≥1周,困难气管插管为气管插管患者拔管后喉喘鸣的独立危险因素;气囊漏气试验敏感度与特异度分别为71.4%和79.7%。结论女性,插管时间≥1周,困难气管插管为气管插管患者拔管后喉喘鸣的独立危险因素;气囊漏气试验预测拔管后喉喘鸣有较高的敏感度与特异度。
Objective To investigate the risk factors of post-extubation stridor and the clinical significance of cuff leak test.Me thods 311 patients admitted in a hospital who were intubated were selected and the risk factors of post-extubation stridor were analyzed.The cuff leak test was given before extubation.Re s ults Of the 311 patients,21 had post-extubation stridor.Logistic regression analysis showed that female,duration of intubation being or more than one week,difficulty intubation were independent risk factors of post-extubation stridor.The sensitivity and the specificity of the cuff leak test were 71.4% and 79.7% respectively.Conclus ion Female,duration of intubation being or more than one week,difficulty intubation were independent risk factors of post-extubation stridor.The method of cuff leak test provides high sensitivity and specificity in predicting post-extubation stridor.
Objective To investigate the risk factors of post-extubation stridor and the clinical significance of cuff leak test.Me thods 311 patients admitted in a hospital who were intubated were selected and the risk factors of post-extubation stridor were analyzed.The cuff leak test was given before extubation.Re s ults Of the 311 patients,21 had post-extubation stridor.Logistic regression analysis showed that female,duration of intubation being or more than one week,difficulty intubation were independent risk factors of post-extubation stridor.The sensitivity and the specificity of the cuff leak test were 71.4% and 79.7% respectively.Conclus ion Female,duration of intubation being or more than one week,difficulty intubation were independent risk factors of post-extubation stridor.The method of cuff leak test provides high sensitivity and specificity in predicting post-extubation stridor.
引文
[1]Zhou T,Zhang HP,Chen WW,et al.Cuff-leak test for predicting postextubation airway complications:a systematic review[J].J Evid Based Med,2011,4(4):242-254.
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[3]J aber S,Jung B,Chanques G,et al.Effects of steroids on reintubation and post-extubation stridor in adults:meta-analysis of randomised controlled trials[J].Critical Care,2009,13(2):1-11.
[4]Girard TD,Alhazzani W,Kress JP,et al.An Official American American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline:Liberation from Mechanical Ventilation in Critically Ill Adults.Rehabilitation Protocols,Ventilator Liberation Protocols,and Cuff Leak Tests[J].American Journal of Respiratory and Critical Care Medicine,2017,195(1):120-133.
[5]Miller RL,Cole RP.Association between reduced cuff leak volume and postextubation stridor[J].Chest,1996,110(4):1035-1040.
[6]中华医学会呼吸病学分会呼吸治疗学组.人工气道气囊的管理专家共识(草案)[J].中华结核和呼吸杂志,2014,37(11):816-819.
[7]余桂永,陈新义.国人气道径线CT测量及其意义[J].中国继续医学教育,2015,7(12):6-7.
[8]何权瀛,王莞尔.阻塞性睡眠呼吸暂停低通气综合征诊治指南(基层版)[J].中华全科医师杂志,2015,14(7):398-405.
[9]Pluijms WA,Mook WNV,Wittekamp BH,et al.Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients:updated review[J].Critical Care,2015,19(1):295-304.
[10]Fan E,Zakhary B,Amaral A,et al.Liberation from Me chanical Ventilation in Critically Ill Adults.An Official ATS/ACCPClinical Practice Guideline[J].Annals of the American Thoracic Society,2017,14(3):441-443.
[11]Maury E,Guglielminotti J,Alzieu M,et al.How to identify patients with no risk for postextubation stridor?[J].Journal of Critical Care,2004,19(1):23-28.
[12]Kriner EJ,Shafazand S,Colice GL.The endotracheal tube cuff-leak test as a predictor for postextubation stridor[J].Respiratory Care,2005,50(12):1632-1638.
[13]Jaber S,Chanques G,Matecki S,et al.Post-extubation stridor in intensive care unit patients.Risk factors evaluation and importance of the cuff-leak test[J].Intensive Care Med,2003,9(1):69-74.
[2]Fran ois B,Bellissant E,Gissot V,et al.12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema:a randomised double-blind trial[J].Lancet,2007,369(9567):1083-1089.
[3]J aber S,Jung B,Chanques G,et al.Effects of steroids on reintubation and post-extubation stridor in adults:meta-analysis of randomised controlled trials[J].Critical Care,2009,13(2):1-11.
[4]Girard TD,Alhazzani W,Kress JP,et al.An Official American American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline:Liberation from Mechanical Ventilation in Critically Ill Adults.Rehabilitation Protocols,Ventilator Liberation Protocols,and Cuff Leak Tests[J].American Journal of Respiratory and Critical Care Medicine,2017,195(1):120-133.
[5]Miller RL,Cole RP.Association between reduced cuff leak volume and postextubation stridor[J].Chest,1996,110(4):1035-1040.
[6]中华医学会呼吸病学分会呼吸治疗学组.人工气道气囊的管理专家共识(草案)[J].中华结核和呼吸杂志,2014,37(11):816-819.
[7]余桂永,陈新义.国人气道径线CT测量及其意义[J].中国继续医学教育,2015,7(12):6-7.
[8]何权瀛,王莞尔.阻塞性睡眠呼吸暂停低通气综合征诊治指南(基层版)[J].中华全科医师杂志,2015,14(7):398-405.
[9]Pluijms WA,Mook WNV,Wittekamp BH,et al.Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients:updated review[J].Critical Care,2015,19(1):295-304.
[10]Fan E,Zakhary B,Amaral A,et al.Liberation from Me chanical Ventilation in Critically Ill Adults.An Official ATS/ACCPClinical Practice Guideline[J].Annals of the American Thoracic Society,2017,14(3):441-443.
[11]Maury E,Guglielminotti J,Alzieu M,et al.How to identify patients with no risk for postextubation stridor?[J].Journal of Critical Care,2004,19(1):23-28.
[12]Kriner EJ,Shafazand S,Colice GL.The endotracheal tube cuff-leak test as a predictor for postextubation stridor[J].Respiratory Care,2005,50(12):1632-1638.
[13]Jaber S,Chanques G,Matecki S,et al.Post-extubation stridor in intensive care unit patients.Risk factors evaluation and importance of the cuff-leak test[J].Intensive Care Med,2003,9(1):69-74.