全麻患者气管插管套囊压力和术后气道并发症的现况调查及影响因素分析
|
摘要
目的调查新疆地区全麻患者气管插管套囊压力及术后插管相关并发症的现状,并分析引起不适套囊压力的影响因素。方法采用整群抽样及单纯随机抽样方法,抽取2017年2—5月新疆地区3家三级甲等医院拟行全身麻醉气管插管并符合纳入标准的患者作为研究对象。登记相关信息,于气管插管后采用一次性压力换能器测量套囊压力,拔管后24h内随访患者,记录术后气管插管相关并发症的发生情况。根据测压结果将患者分为套囊压力正常组(20~30cmH_2O)与套囊压力异常组(<20cmH_2O或>30cmH_2O),通过Logistic回归分析引起套囊压力过高或过低的危险因素。结果共纳入研究对象430例,气管导管套囊压力为(53.3±20.5)cmH_2O,仅有82例(19.1%)患者套囊压力在推荐范围。术后气道并发症主要有:咽喉痛305例(70.9%),声音嘶哑159例(37.0%),咳嗽147例(34.2%),血丝痰145例(33.7%)。Logistic回归分析显示,BMI≥27kg/m~2(OR=11.000,95%CI 1.064~113.731)、术前气道特殊情况(吸烟、哮喘等,OR=2.809,95%CI1.300~6.070)、麻醉科医师职称(住院医师,OR=60.224,95%CI 18.853~192.380;主治医师,OR=7.364,95%CI 3.112~17.426)和工龄(≤5年,OR=68.500,95%CI 15.253~307.619;6~10年,OR=10.400,95%CI 4.430~24.417)是导致患者出现不适套囊压力升高的危险因素。结论临床工作中套囊压力远高于推荐值,插管相关并发症发生率高,而术前患者肥胖、有吸烟史或合并哮喘、气管炎,麻醉科医师职称较低、工作时间较短是导致气管导管套囊压力异常的危险因素。
Objective To explore the current situation of endotracheal tube cuff pressure and postoperative intubation-related complications in patients under general anesthesia,and to analyze the influencing factors for excessive and insufficient cuff pressure.Methods The patients who met inclusion criteria in three hospitals in Xinjiang province,scheduled for surgery under general anesthesia with endotracheal intubation from February to May 2017 were selected using cluster sampling method and simple random sampling method.The cuff pressure was measured using a traditional pressure transducer after intubation.The patients were followed-up 24 hafter extubation to observe postoperative intubation-related complications.In accordance with the measured cuff pressure,82 patients were regarded as normal cuff pressure group and 348 patients were designated as abnormal cuff pressure group.Comparison of clinical data between the two groups and multivariable logistic regression analysis were performed to predict the risk factors of excessive and insufficient cuff pressure.Results A total of 430 patients were included in the study.The measured pressure was(53.3±20.5)cmH_2 O,and only 82 patients had a cuff pressure within the recommended range of 20-30 cmH_2 O with a probability of 19.1%.Cases and incidences of sore throat,hoarseness,cough,and blood-streaked expectorant after operative was 305(70.9%),159(37.0%),147(34.2%),and 145(33.7%),respectively.Multivariate logistic regression analysis demonstrated that BMI≥27 kg/m~2(OR=11.000,95%CI 1.064-113.731),smoking history,asthma,or bronchitis history(OR=2.809,95% CI 1.300-6.070)in patients and the title of anesthesiologists(resident,OR =60.224,95% CI 18.853-192.380)who inflated the cuff and their working years(≤5 years,OR=68.500,95% CI 15.253-307.619;6-10 years,OR=10.400,95%CI 4.430-24.417)were the independent risk factors of improper cuff pressure.Conclusion Cuff pressure is much higher than the recommended range in clinical practice and the incidence of intubation-related complications is quite high.Preoperative obesity,smoking history,asthma,or bronchitis history of patients,lower professional title and shorter working years of anesthesiologists are risk factors of abnormal endotracheal tube cuff pressure.
Objective To explore the current situation of endotracheal tube cuff pressure and postoperative intubation-related complications in patients under general anesthesia,and to analyze the influencing factors for excessive and insufficient cuff pressure.Methods The patients who met inclusion criteria in three hospitals in Xinjiang province,scheduled for surgery under general anesthesia with endotracheal intubation from February to May 2017 were selected using cluster sampling method and simple random sampling method.The cuff pressure was measured using a traditional pressure transducer after intubation.The patients were followed-up 24 hafter extubation to observe postoperative intubation-related complications.In accordance with the measured cuff pressure,82 patients were regarded as normal cuff pressure group and 348 patients were designated as abnormal cuff pressure group.Comparison of clinical data between the two groups and multivariable logistic regression analysis were performed to predict the risk factors of excessive and insufficient cuff pressure.Results A total of 430 patients were included in the study.The measured pressure was(53.3±20.5)cmH_2 O,and only 82 patients had a cuff pressure within the recommended range of 20-30 cmH_2 O with a probability of 19.1%.Cases and incidences of sore throat,hoarseness,cough,and blood-streaked expectorant after operative was 305(70.9%),159(37.0%),147(34.2%),and 145(33.7%),respectively.Multivariate logistic regression analysis demonstrated that BMI≥27 kg/m~2(OR=11.000,95%CI 1.064-113.731),smoking history,asthma,or bronchitis history(OR=2.809,95% CI 1.300-6.070)in patients and the title of anesthesiologists(resident,OR =60.224,95% CI 18.853-192.380)who inflated the cuff and their working years(≤5 years,OR=68.500,95% CI 15.253-307.619;6-10 years,OR=10.400,95%CI 4.430-24.417)were the independent risk factors of improper cuff pressure.Conclusion Cuff pressure is much higher than the recommended range in clinical practice and the incidence of intubation-related complications is quite high.Preoperative obesity,smoking history,asthma,or bronchitis history of patients,lower professional title and shorter working years of anesthesiologists are risk factors of abnormal endotracheal tube cuff pressure.
引文
[1]Jaber S,Amraoui J,Lefrant JY,et al.Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit:aprospective,multiplecenter study.Crit Care Med,2006,34(9):2355-2361.
[2]Bolzan DW,Guizilini S,Faresin SM,et al.Endotracheal tube cuff pressure assessment maneuver induces drop of expired tidal volume in the postoperative of coronary artery bypass grafting.J Cardiothorac Surg,2012,7(1):1-5.
[3]Sultan P,Carvalho B,Rose BO,et al.Endotracheal tube cuff pressure monitoring:a review of the evidence.J Perioper Pract,2011,21(11):379-386.
[4]Nseir S,Zerimech F,Fournier C,et al.Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients.Am J Respir Crit Care Med,2011,184(9):1041-1047.
[5]Akdogan O,Ersoy Y,Kuzucu C,et al.Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization.Braz J Infect Dis,2017,21(3):276-281.
[6]Touat L,Fournier C,Ramon P,et al.Intubation-related tracheal ischemic lesions:incidence,risk factors,and outcome.Intensive Care Med,2013,39(4):575-582.
[7]Harvie DA,Darvall JN,Dodd M,et al.The minimal leak test technique for endotracheal cuff maintenance.Anaesth Intensive Care,2016,44(5):599-604.
[8]Ozer AB,Demirel I,Gunduz G,et al.Effects of user experience and method in the inflation of endothacheal tube pilot balloon on cuff pressure.Niger J Clin Pract,2013,16(2):253-257.
[9]Lovett PB,Flaxman A,Stürmann KM,et al.The insecure airway:a comparison of knots and commercial devices for securing endotracheal tubes.BMC Emerg Med,2006,6(1):7.
[10]Ganigara A,Ramavakoda CY.Continuous real time endotracheal tube cuff pressure waveform.J Clin Monit Comput,2014,28(4):433-434.
[11]Nseir S,Duguet A,Copin MC,et al.Continuous control of endotracheal cuff pressure and tracheal wall damage:a randomized controlled animal study.Critical Care,2007,11(5):R109.
[12]Lizy C,Swinnen W,Labeau S,et al.Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation.Am J Crit Care,2014,23(1):1-8.
[13]Geng G,Hu J,Huang S.The effect of endotracheal tube cuff pressure change during gynecological laparoscopic surgery on postoperative sore throat:a control study.J Clin Monit Comput,2015,29(1):141-144.
[14]Kamata M,Hakim M,Tumin D,et al.The effect of transesophageal echocardiography probe placement on intracuff pressure of an endotracheal tube in infants and children.J Cardiothorac Vasc Anesth,2016,31(2):543-548.
[15]Abdeyrim A,Zhang Y,Li N,et al.Impact of obstructive sleep apnea on lung volumes and mechanical properties of the respiratory system in overweight and obese individuals.BMC Pulm Med,2015,15(1):76.
[16]Ekstrom S,Hallberg J,Kull I,et al.Body mass index status and peripheral airway obstruction in school-age children:a population-based cohort study.Thorax,2018,73(6):538-545.
[17]Zhao X,Huang S,Wang Z,et al.Relationship between respiratory dynamics and body mass index in patients undergoing general anesthesia with laryngeal mask airway(LMA)and comparison between lithotomy and supine positions.Med Sci Monit,2016,22:2706-2713.
[18]Kougias M,Vardavas CI,Anagnostopoulos N,et al.The acute effect of cigarette smoking on the respiratory function and FENO production among young smokers.Exp Lung Res,2013,39(8):359-364.
[19]Robinson PD,King GG,Sears MR,et al.Determinants of peripheral airway function in adults with and without asthma.Respirology,2017,22(6):1110-1117.
[20]Carhart E,Stuck LH,Salzman JG.Achieving a safe endotracheal tube cuff pressure in the prehospital setting:is it time to revise the standard cuff inflation practice?Prehosp Emerg Care,2016,20(2):273-277.
[21]Annoni R,de Almeida Junior AE.Handcrafted cuff manometers do not accurately measure endotracheal tube cuff pressure.Rev Bras Ter Intensiva,2015,27(3):228-234.
[22]Giusti GD,Rogari C,Gili A,et al.Cuff pressure monitoring by manual palpation in intubated patients:how accurate is it?A manikin simulation study.Aust Crit Care,2017,30(4):234-238.
[23]Ozcan ATD,Doger C,But A,et al.Comparison of endotracheal tube cuff pressure values before and after training seminar.J Clin Monit Comput,2018,32(3):527-531.
[2]Bolzan DW,Guizilini S,Faresin SM,et al.Endotracheal tube cuff pressure assessment maneuver induces drop of expired tidal volume in the postoperative of coronary artery bypass grafting.J Cardiothorac Surg,2012,7(1):1-5.
[3]Sultan P,Carvalho B,Rose BO,et al.Endotracheal tube cuff pressure monitoring:a review of the evidence.J Perioper Pract,2011,21(11):379-386.
[4]Nseir S,Zerimech F,Fournier C,et al.Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients.Am J Respir Crit Care Med,2011,184(9):1041-1047.
[5]Akdogan O,Ersoy Y,Kuzucu C,et al.Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization.Braz J Infect Dis,2017,21(3):276-281.
[6]Touat L,Fournier C,Ramon P,et al.Intubation-related tracheal ischemic lesions:incidence,risk factors,and outcome.Intensive Care Med,2013,39(4):575-582.
[7]Harvie DA,Darvall JN,Dodd M,et al.The minimal leak test technique for endotracheal cuff maintenance.Anaesth Intensive Care,2016,44(5):599-604.
[8]Ozer AB,Demirel I,Gunduz G,et al.Effects of user experience and method in the inflation of endothacheal tube pilot balloon on cuff pressure.Niger J Clin Pract,2013,16(2):253-257.
[9]Lovett PB,Flaxman A,Stürmann KM,et al.The insecure airway:a comparison of knots and commercial devices for securing endotracheal tubes.BMC Emerg Med,2006,6(1):7.
[10]Ganigara A,Ramavakoda CY.Continuous real time endotracheal tube cuff pressure waveform.J Clin Monit Comput,2014,28(4):433-434.
[11]Nseir S,Duguet A,Copin MC,et al.Continuous control of endotracheal cuff pressure and tracheal wall damage:a randomized controlled animal study.Critical Care,2007,11(5):R109.
[12]Lizy C,Swinnen W,Labeau S,et al.Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation.Am J Crit Care,2014,23(1):1-8.
[13]Geng G,Hu J,Huang S.The effect of endotracheal tube cuff pressure change during gynecological laparoscopic surgery on postoperative sore throat:a control study.J Clin Monit Comput,2015,29(1):141-144.
[14]Kamata M,Hakim M,Tumin D,et al.The effect of transesophageal echocardiography probe placement on intracuff pressure of an endotracheal tube in infants and children.J Cardiothorac Vasc Anesth,2016,31(2):543-548.
[15]Abdeyrim A,Zhang Y,Li N,et al.Impact of obstructive sleep apnea on lung volumes and mechanical properties of the respiratory system in overweight and obese individuals.BMC Pulm Med,2015,15(1):76.
[16]Ekstrom S,Hallberg J,Kull I,et al.Body mass index status and peripheral airway obstruction in school-age children:a population-based cohort study.Thorax,2018,73(6):538-545.
[17]Zhao X,Huang S,Wang Z,et al.Relationship between respiratory dynamics and body mass index in patients undergoing general anesthesia with laryngeal mask airway(LMA)and comparison between lithotomy and supine positions.Med Sci Monit,2016,22:2706-2713.
[18]Kougias M,Vardavas CI,Anagnostopoulos N,et al.The acute effect of cigarette smoking on the respiratory function and FENO production among young smokers.Exp Lung Res,2013,39(8):359-364.
[19]Robinson PD,King GG,Sears MR,et al.Determinants of peripheral airway function in adults with and without asthma.Respirology,2017,22(6):1110-1117.
[20]Carhart E,Stuck LH,Salzman JG.Achieving a safe endotracheal tube cuff pressure in the prehospital setting:is it time to revise the standard cuff inflation practice?Prehosp Emerg Care,2016,20(2):273-277.
[21]Annoni R,de Almeida Junior AE.Handcrafted cuff manometers do not accurately measure endotracheal tube cuff pressure.Rev Bras Ter Intensiva,2015,27(3):228-234.
[22]Giusti GD,Rogari C,Gili A,et al.Cuff pressure monitoring by manual palpation in intubated patients:how accurate is it?A manikin simulation study.Aust Crit Care,2017,30(4):234-238.
[23]Ozcan ATD,Doger C,But A,et al.Comparison of endotracheal tube cuff pressure values before and after training seminar.J Clin Monit Comput,2018,32(3):527-531.