气管插管患者使用锥形和柱形套囊导管的气囊压力变化比较分析
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摘要
目的比较分析气管插管患者使用锥形和柱形套囊导管的气囊压力变化。方法将2016年12月至2017年10月急诊科抢救区经口气管插管患者80例,按入院顺序进行编号,奇数组患者应用锥形套囊气管导管(以下简称锥形组),偶数组患者应用柱形套囊气管导管(以下简称柱形组)。最终有48例患者纳入研究,其中锥形组25例,柱形组23例。比较两组患者维持正常气囊压力的总时间、气囊压力(平均压力值,压力最大值与压力最小值)。结果两组患者维持正常气囊压力的总时间、气囊压力(平均压力值,压力最大值与压力最小值)比较,差异具有统计学意义(均P<0.05),其中锥形组患者气囊压力维持正常压力的总时间少于柱形组,气囊压力平均压力值小于柱形组,压力最大值大于柱形组患者,压力最小值小于柱形组。结论与柱形套囊导管相比,锥形套囊导管气囊压力维持在正常范围的时间更短,锥形套囊导管更易产生较高或较低的气囊压力,需加强锥形套囊导管的气囊压力监测,以保证良好的气道封闭效果,减少人工气道并发症。
Objective To investigate the pressure changes of cuff in the tapered-cuff endotracheal tubes and the frequency of cuff pressure monitoring in patient with trachea intubation. Methods From December 2016 to October 2017, 80 patients with oral tracheal intubation in the emergency department were divided into group A(n =25) and group B(n =23) according to the principle of randomized control. Group A with odd number was treated and tapered-cuff endotracheal tubes and group B with ever number and cylindrical-cuff endotracheal tubes. Continuous cuff pressure monitoring device was used to continuously monitor the cuff pressure. The two groups were compared in terms of time for keeping the normal cuff pressure and cuff pressure(average pressure, maximum pressure and minimum pressure). Results The total time for keeping the normal cuff pressure in group A was significantly shorter than that in group B(P<0.05). The average cuff pressure in group A was smaller than that of group B(P<0.05). The maximum pressure in group A is larger than that in group B and the maximum cuff pressure in group A was smaller than that of group B(P<0.05). Conclusion Compared with the cylindrical cuff catheter, the tapered-cuff tube can maintain the normal pressure for a shorter period and easily produce needed pressure. It is a need to enhance the monitoring of cuff pressure to ensure good airway closure and reduce artificial airway complications.
Objective To investigate the pressure changes of cuff in the tapered-cuff endotracheal tubes and the frequency of cuff pressure monitoring in patient with trachea intubation. Methods From December 2016 to October 2017, 80 patients with oral tracheal intubation in the emergency department were divided into group A(n =25) and group B(n =23) according to the principle of randomized control. Group A with odd number was treated and tapered-cuff endotracheal tubes and group B with ever number and cylindrical-cuff endotracheal tubes. Continuous cuff pressure monitoring device was used to continuously monitor the cuff pressure. The two groups were compared in terms of time for keeping the normal cuff pressure and cuff pressure(average pressure, maximum pressure and minimum pressure). Results The total time for keeping the normal cuff pressure in group A was significantly shorter than that in group B(P<0.05). The average cuff pressure in group A was smaller than that of group B(P<0.05). The maximum pressure in group A is larger than that in group B and the maximum cuff pressure in group A was smaller than that of group B(P<0.05). Conclusion Compared with the cylindrical cuff catheter, the tapered-cuff tube can maintain the normal pressure for a shorter period and easily produce needed pressure. It is a need to enhance the monitoring of cuff pressure to ensure good airway closure and reduce artificial airway complications.
引文
[1]中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-536.
[2]J SHIOTSUKA,A T LEFOR,M SANUI.et al.A quantitative evaluation of fluid leakage around a polyvinyl chloride tapered endotracheal tube cuff using an in-vitro model[J].HSR Proc Intensive Care Cardiovasc Anesth,2012,4(3):169-175.
[3]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):169-172.
[4]EUNKYUNG CHOI,YONGMIN PARK,YOUNGHOONJEON,et al.Comparison of the cuff pressure of a TaperGuard endotracheal tube and a ylindrical endotracheal tube after lateral rotation of head during middle ear surgery[J].Medicine,2017,96(10):e6257.
[5]EFRATI S,DEUTSCH I et al.Tracheal prussure and endotracheal tube obstruction can be detected by continuous cuff pressure monitoring:in vitro pilot study[J].Intensive Care Med,2010,36:984-990.
[6]HOFFMAN RJ,DAHLEN JR,LIPOVIC D,et al.Linear correlation of endotracheal tube cuff pressure and volume[J].West J Emerg Med,2009,10(3):137-139.
[7]吴彦烁,宿桂霞,尹艳玲,等.4种临床因素对人工气道气囊压力的影响[J].中华护理杂志,2017,52(8):934-937.
[8]MONSEL A,LU Q,LE CORRE M,et al.Tapered-cuff endotracheal tube does not prevent early postoperative pneumonia compared with spherical-cuff endotracheal tube after major vascular surgery[J].Anesthesiology,2016,124(5):1041-1052.
[2]J SHIOTSUKA,A T LEFOR,M SANUI.et al.A quantitative evaluation of fluid leakage around a polyvinyl chloride tapered endotracheal tube cuff using an in-vitro model[J].HSR Proc Intensive Care Cardiovasc Anesth,2012,4(3):169-175.
[3]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):169-172.
[4]EUNKYUNG CHOI,YONGMIN PARK,YOUNGHOONJEON,et al.Comparison of the cuff pressure of a TaperGuard endotracheal tube and a ylindrical endotracheal tube after lateral rotation of head during middle ear surgery[J].Medicine,2017,96(10):e6257.
[5]EFRATI S,DEUTSCH I et al.Tracheal prussure and endotracheal tube obstruction can be detected by continuous cuff pressure monitoring:in vitro pilot study[J].Intensive Care Med,2010,36:984-990.
[6]HOFFMAN RJ,DAHLEN JR,LIPOVIC D,et al.Linear correlation of endotracheal tube cuff pressure and volume[J].West J Emerg Med,2009,10(3):137-139.
[7]吴彦烁,宿桂霞,尹艳玲,等.4种临床因素对人工气道气囊压力的影响[J].中华护理杂志,2017,52(8):934-937.
[8]MONSEL A,LU Q,LE CORRE M,et al.Tapered-cuff endotracheal tube does not prevent early postoperative pneumonia compared with spherical-cuff endotracheal tube after major vascular surgery[J].Anesthesiology,2016,124(5):1041-1052.