急诊科气管插管患者套囊压力水平及其影响因素分析
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摘要
目的收集急诊科门诊及急诊重症监护室(intensive care unit,ICU)行气管插管患者套囊压力的水平并分析套囊压力异常的影响因素。方法以任意抽样的方法,采用一次性压力换能器测量新疆石河子大学医学院第一附属医院2017-11至2018-03在急诊科门诊及急诊ICU行气管插管患者的套囊压力。记录患者的一般临床资料,以及为其行套囊充气麻醉医师的职称、工作时间、学历、既往对套囊压力相关知识认知情况、既往有无进行过套囊压力方面继续教育等情况。采用Logistic回归分析引起套囊压力异常的影响因素。结果共纳入86例,测得急诊科气管插管患者套囊压力为(68.4±22.6)cm H_2O(1 cm H_2O=0.098 kPa),其中23例套囊压力在正常范围(20~30 cm H_2O)。经Logistic回归分析显示,职称、工龄、对套囊相关知识认知程度、是否接受过套囊压力相关知识专业培训、插管环境均可能是导致气管插管套囊压力异常的独立危险因素(P<0.05)。结论临床中应采取一定的办法进行套囊压力监测,同时可开展套囊压力相关培训,对麻醉医生进行毕业后再教育,以降低不合适套囊压力的发生率。
Objective The objective of this study was to collect the level of capsular pressure in tracheal intubation patients in the emergency department and emergency intensive care unit(ICU), and analyze the influencing factors of abnormal pressure. MethodsPatients who were undergoing tracheal intubation in the outpatient and emergency ICU of the First Affiliated Hospital of Xinjiang Shihezi University Medical college were selected. Their capsular pressures were measured using disposable pressure transducer. The general clinical data of the patients as well as the on-duty anesthetist's professional title, working years, educational background, knowledge about the capsule pressure, and any further education on capsule pressure were recorded. The factors that caused the abnormal pressure of the sac were analyzed by Logistic regression analysis. Results A total of 86 patients were included and the pressure of the sac was(68.4±22.6) cm H_2O in the emergency department of tracheal intubation, of which 23 cases were within the normal range of 20~30 cm H_2O. The Logisticregression analysis showed that professional title, working years, knowledge of the sac, professional training and the intubation environment were correlated with abnormal tracheal intubation pressure(P<0.05). Conclusions It is necessary to take steps to monitor the pressure of the bursa. At the same time, we should carry out training courses related to cuff pressure and to re-educate anesthesiologists after graduation to reduce the incidence of unsuitable cuff pressure.
Objective The objective of this study was to collect the level of capsular pressure in tracheal intubation patients in the emergency department and emergency intensive care unit(ICU), and analyze the influencing factors of abnormal pressure. MethodsPatients who were undergoing tracheal intubation in the outpatient and emergency ICU of the First Affiliated Hospital of Xinjiang Shihezi University Medical college were selected. Their capsular pressures were measured using disposable pressure transducer. The general clinical data of the patients as well as the on-duty anesthetist's professional title, working years, educational background, knowledge about the capsule pressure, and any further education on capsule pressure were recorded. The factors that caused the abnormal pressure of the sac were analyzed by Logistic regression analysis. Results A total of 86 patients were included and the pressure of the sac was(68.4±22.6) cm H_2O in the emergency department of tracheal intubation, of which 23 cases were within the normal range of 20~30 cm H_2O. The Logisticregression analysis showed that professional title, working years, knowledge of the sac, professional training and the intubation environment were correlated with abnormal tracheal intubation pressure(P<0.05). Conclusions It is necessary to take steps to monitor the pressure of the bursa. At the same time, we should carry out training courses related to cuff pressure and to re-educate anesthesiologists after graduation to reduce the incidence of unsuitable cuff pressure.
引文
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[14]Guyton D C,Barlow M R,Besselievre T R.Influence of airway pressure on minimum occlusive endotracheal tube cuff pressure[J].Crit Care Med,1997,25(1):91-94.
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[17]Annoni R,de Almeida Junior A E.Handcrafted cuff manometers do not accurately measure endotracheal tube cuff pressure[J].Rev Bras Ter Intensiva,2015,27(3):228-234.DOI:10.5935/0103-507X.20150037.
[18]Doyle D J.Digital display of endotracheal tube cuff pressures made simple[J].Anesthesiology,1999,91(1):329.
[19]Sole M L,Aragon D,Bennett M,et al.Continuous measurement of endotracheal tube cuff pressure:How difficult can it be?[J].AACN Adv Crit Care,2008,19(2):235 -243.DOI:10.1097/01.AACN.0000318126.79630.76.
[20]Kumar J M,Bushan T C.Endotracheal tube cuff pressure monitoring during neurosurgery-manual vs.automatic method[J].J Anaesthesiol Clin Pharmacol,2011,27(3):358-361.DOI:10.4103/0970-9185.83682.
[21]Klompas M,Branson R,Eichenwald E C,et al.Strategies to prevent ventilator-associated pneumonia in acute care hospitals:2014 update[J].Infect Control Hosp Epidemiol,2014,35(8):915-936.DOI:10.1086/591062.
[22]Lucangelo U,Zin W A,Antonaglia V,et al.Effect of positive expiratory pressure and type of tracheal cuff on the incidence of aspiration in mechanically ventilated patients in an intensive care unit[J].Crit Care Med,2008,36(2):409-413.DOI:10.1097/01.CCM.0000297888.82492.31.
[23]Rello J,Sonora R,Jubert P,et al.Pneumonia in intubated patients:role of respiratory airway care[J].Am J Respir Crit Care Med,1996,154(1):111-115.DOI:10.1164/ajrccm.154.1.8680665.
[24]Svenson J E,Lindsay M B,O'Connor J E.Endotracheal intracuff pressures in the ED and prehospital setting:is there a problem?[J].Am J Emerg Med,2007,25(1):53-56.
[25]Parwani V,Hoffman R J,Russell A,et al.Practicing paramedics cannot generate or estimate safe endotracheal tube cuff pressure using standard techniques[J].Prehosp Emerg Care,2007,11(3):307-311.DOI:10.1080/10903120701348248.
[26]Galinski M,Treoux V,Garrigue B,et al.Intracuff pressures of endotracheal tubes in the management of airway emergencies:the need for pressure monitoring[J].Ann Emerg Med,2006,47(6):545-547.
[27]Wujtewicz M A,Sawicka W,Owczuk R,et al.Tracheal tube cuff pressure depends on the anaesthesiologist's experience.A follow-up study[J].Anestezjol Intens Ter,2009,41(4):205-208.
[28]ATD?,D??er C,But A,et al.Comparison of endotracheal tube cuff pressure values before and after training seminar[J].J Clin Monit Comput,2017(2):1-5.DOI:10.1007/s10877-017-0046-7.
[2]Sultan P,Carvalho B,Rose B O,et al.Endotracheal tube cuff pressure monitoring:a review of the evidence[J].J Perioper Pract,2011,21(11):379-386.DOI:10.1177/175045891102101103.
[3]Dullenkopf A,Gerber A,Weiss M.Fluid leakage past tracheal tube cuffs:evaluation of the new microcuff endotracheal tube[J].Intensive care med,2003,29(10):1849-1853.DOI:10.1007/s00134-003-1933-6.
[4]Mehta S,Myat H M.The cross-sectional shape and circumference of the human trachea[J].Ann R Coll of Surg Engl,1984,66(5):356-358.
[5]Weiss M,Doell C,Koepfer N,et al.Rapid pressure compensation by automated cuff pressurecontrollers worsens sealing in tracheal tubes[J].Br J Anaesth,2009,102(2):273-278.
[6]Touat L,Fournier C,Ramon P,et al.Intubation-related tracheal ischemic lesions:incidence,risk factors,and outcome[J].Intensive Care Med,2013,39(4):575-582.DOI:10.1007/s00134-012-2750-6.
[7]孙霞,陈家伟,尹华,等.气管导管套囊压力与患者气道黏膜损伤程度的关系[J].中国临床医学,2011,18(5):688-689.DOI:10.3969/j.issn.1008-6358.2011.05.042.
[8]李惟一,范灵云,耿桂启,等.气管导管不同套囊压力对全身麻醉气管插管时心血管反应的影响[J].中国临床医学,2015,22(2):192-194.
[9]Lovett P B,Flaxman A,Stürmann K M,et al.The insecure airway:a comparison of knots and commercial devices for securing endotracheal tubes[J].BMC Emerg Med,2006,6(1):7.DOI:10.1186/1471-227X-6-7.
[10]Seegobin R D,van Hasselt G L.Endotracheal cuff pressure and tracheal mucosal blood flow:endoscopic study of effects of four large volume cuffs[J].Br Med J(Clin Res Ed),1984,288(6422):965-968.
[11]Bernon J K,Mc Guire C I,Carrara H,et al.Endotracheal tube cuff pressures-the worrying reality:a comparative audit of intra-operative versus emergency intubations[J].S Afr Med J,2013,103(9):641-643.DOI:10.7196/samj.6638.
[12]Briganti A,Portela D A,Barsotti G,et al.Evaluation of the endotracheal tube cuff pressure resulting from four different methods of inflation in dogs[J].Vet Anaesth Analg,2012,39(5):488-494.DOI:10.1111/j.1467-2995.2012.00719.x.
[13]Sole M L,Bennett M.Comparison of airway management practices between registered nurses and respiratory care practitioners[J].Am J Crit Care,2014,23(3):191-200.DOI:10.4037/ajcc2014424.
[14]Guyton D C,Barlow M R,Besselievre T R.Influence of airway pressure on minimum occlusive endotracheal tube cuff pressure[J].Crit Care Med,1997,25(1):91-94.
[15]Nee P A,Benger J,Walls R M.Airway management[J].Emerg Med J,2008,25(2):98-102.DOI:10.1136/emj.2005.030635.
[16]Carhart E,Stuck L H,Salzman J G.Achieving a safe endotracheal tube cuff pressure in the prehospital setting:Is it time to revise the standard cuff inflation practice?[J].Prehosp Emerg Care,2016,20(2):273-277.DOI:10.3109/10903127.2015.1061626.
[17]Annoni R,de Almeida Junior A E.Handcrafted cuff manometers do not accurately measure endotracheal tube cuff pressure[J].Rev Bras Ter Intensiva,2015,27(3):228-234.DOI:10.5935/0103-507X.20150037.
[18]Doyle D J.Digital display of endotracheal tube cuff pressures made simple[J].Anesthesiology,1999,91(1):329.
[19]Sole M L,Aragon D,Bennett M,et al.Continuous measurement of endotracheal tube cuff pressure:How difficult can it be?[J].AACN Adv Crit Care,2008,19(2):235 -243.DOI:10.1097/01.AACN.0000318126.79630.76.
[20]Kumar J M,Bushan T C.Endotracheal tube cuff pressure monitoring during neurosurgery-manual vs.automatic method[J].J Anaesthesiol Clin Pharmacol,2011,27(3):358-361.DOI:10.4103/0970-9185.83682.
[21]Klompas M,Branson R,Eichenwald E C,et al.Strategies to prevent ventilator-associated pneumonia in acute care hospitals:2014 update[J].Infect Control Hosp Epidemiol,2014,35(8):915-936.DOI:10.1086/591062.
[22]Lucangelo U,Zin W A,Antonaglia V,et al.Effect of positive expiratory pressure and type of tracheal cuff on the incidence of aspiration in mechanically ventilated patients in an intensive care unit[J].Crit Care Med,2008,36(2):409-413.DOI:10.1097/01.CCM.0000297888.82492.31.
[23]Rello J,Sonora R,Jubert P,et al.Pneumonia in intubated patients:role of respiratory airway care[J].Am J Respir Crit Care Med,1996,154(1):111-115.DOI:10.1164/ajrccm.154.1.8680665.
[24]Svenson J E,Lindsay M B,O'Connor J E.Endotracheal intracuff pressures in the ED and prehospital setting:is there a problem?[J].Am J Emerg Med,2007,25(1):53-56.
[25]Parwani V,Hoffman R J,Russell A,et al.Practicing paramedics cannot generate or estimate safe endotracheal tube cuff pressure using standard techniques[J].Prehosp Emerg Care,2007,11(3):307-311.DOI:10.1080/10903120701348248.
[26]Galinski M,Treoux V,Garrigue B,et al.Intracuff pressures of endotracheal tubes in the management of airway emergencies:the need for pressure monitoring[J].Ann Emerg Med,2006,47(6):545-547.
[27]Wujtewicz M A,Sawicka W,Owczuk R,et al.Tracheal tube cuff pressure depends on the anaesthesiologist's experience.A follow-up study[J].Anestezjol Intens Ter,2009,41(4):205-208.
[28]ATD?,D??er C,But A,et al.Comparison of endotracheal tube cuff pressure values before and after training seminar[J].J Clin Monit Comput,2017(2):1-5.DOI:10.1007/s10877-017-0046-7.