防止兔胃内容物反流的球囊内最低有效压力的研究  

The lowest effective pressure in cuff preventing gastric reflux： a study on rabbit

作　　者：罗林丽[1] 周俊[2] 李华凤[1] 倪娟[1] 黄伟[1] 黄蔚[1] 

机构地区：[1]四川大学华西第二医院麻醉科妇女疾病与出生缺陷教育部重点实验室,成都610041 [2]四川大学华西口腔医院麻醉科,成都610041

出　　处：《中国急救医学》2010年第11期1012-1015,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨防止兔胃内容物反流的食道阻塞管球囊内的最低有效压力.方法 22只新西兰大白兔,体质量2.0~2.5 kg.麻醉后向食道内插入ID 3.5 cm带球囊气管导管作为食管阻塞管,并向球囊内充气封堵食管.使用三通分别连接弹簧表和注射器测量和调节球囊内的压力.通过食管阻塞管插入塑料管到胃内作为胃管,并注入含有亚甲蓝的生理盐水模拟饱胃状态.沿食管阻塞管外壁插入反流物观察管,维持球囊内压力在预定水平5 min后,抽吸观察管,观察是否有亚甲蓝生理盐水流出.如果有就定义为反流实验＂阳性＂,相反为＂阴性＂.球囊内起始压力为120 cm H2O,如果前一只兔的反流实验为＂阳性＂,则下一只兔的球囊内压力就升高10 cm H2O,反之,就降低10 cm H2O,直到观察到6个从＂阴性＂到＂阳性＂的交叉点后终止研究.防止50%和95%的兔发生胃内容物反流的球囊内最低有效压力值采用Logistic回归分析.结果 防止50%的动物发生胃内容物反流的球囊内最低有效压力值Pre50为61.98 cm H2O（51.00~69.61 cm H2O）,防止95%的动物发生胃内容物反流的球囊内最低有效压力值Pre95为74.40 cm H2O（67.43~84.38 cm H2O）.结论 维持食道阻塞管球囊内一定的压力可以在短期内有效防止浅麻醉下兔胃内容物反流.Objective To investigate the lowest effective pressure in cuff for preventing gastric reflux on rabbit. Methods Twenty - two New Zealand white rabbit, weighted between 2.0 - 2.5 kg were randomly selected. After general anesthesia, an ID 3.5 cm tube catheter was put into and fulfilled with gas in cuff to block esophagus, and then a T tube was used to connect the pressure spring detector and injector to measure and adjust the pressure inside esophageal block tube cuff. Inside of which a tube was inserted into stomach as a gastric tube, while around of which a thinner tube was inserted for observation. Then, the normal saline with methylene blue was injected through the gastric tube to mimic the full stomach until the saline flow out from esophageal block tube. The inner cuff pressure was maintained at preset level for 5 min to observe if the normal saline flew out. Reflux trial was ＂positive＂ if it did, and ＂negative＂ if it didn＇t. The initial pressure in block tube cuff was 120 cm H20. If the reflux trial was ＂positive＂ in first rabbit, then the block tube cuff pressure was increased 10 cm H20 in the following rabbit, vise versa, until 6 crossover points was observed from ＂negative＂ to ＂positive＂. The Logistic regression analysis was used to calculate the lowest effective pressure in esophageal block tube cuff when 50% and 95% rabbits had gastric reflux. Results The lowest effective pressure for preventing 50% rabbits from gastric reflex （PreS0） was 61.98 cm H20 （95% confidence interval： 51.00 N 69.61 cm H2 O） and the lowest effective pressure for preventing 95 % rabbits from gastric reflex （Pre95）was 74. 40 cm H2O （95% confidence interval： 67.43 - 84.38 cm H2O）. Conclusion The maintenance of certain pressure inside the esophageal block tube cuff is effective for preventing the gastric reflux on rabbit under a light anesthesia in short term.

关 键 词：最低有效压力 胃内容物反流 球囊 食管 

分 类 号：R614.2[医药卫生—麻醉学]