预防兔气管黏膜损伤的导管套囊内的最低有效压力  

The lowest effective pressure in cuff preventing the endotracheal mucosal injury on rabbit

作　　者：阮履强 罗林丽[2] 周军 王洪阳 王利洋 

机构地区：[1]四川省内江市中医院麻醉科,641001 [2]四川大学华西第二医院麻醉科

出　　处：《临床麻醉学杂志》2012年第9期919-921,共3页Journal of Clinical Anesthesiology

基　　金：四川省科技厅科技支撑计划项目资助(2010GZ0293)

摘　　要：目的探讨防止兔气管黏膜损伤的气管导管套囊内的最低有效压力。方法 22只新西兰大白兔。麻醉后向气管内插入ID3.5cm带套囊气管导管并向套囊内充气。使用三通分别连接压力弹簧表和注射器测量和调节套囊内的压力。维持套囊内压力在预定水平2h后处死大白兔,取套囊压迫区气管组织行病理观察。如果光镜下病理切片显示黏膜受损就定义为压力实验"阳性",相反就定义为压力实验"阴性"。气管导管套囊内的起始压力设定为50cmH2O,如果前一只兔的压力实验为"阳性",则下一只兔的气管导管套囊内的压力就降低5cmH2O,反之则下一只兔的气管导管套囊内的压力就升高5cmH2O,直到观察到六个从"阴性"到"阳性"的交叉点后终止全部实验。结果防止50%的兔发生气管黏膜损伤的套囊内最低有效压力值Pre50为24.83cmH2O(95%可信区间:21.27～28.29cmH2O),防止95%的兔发生气管黏膜损伤的套囊内最低有效压力值Pre95为18.19cmH2O(95%可信区间:14.29～22.31cmH2O)。结论维持兔气管导管套囊内压力在20cmH2O内可以在短期内有效防止兔气管黏膜损伤。Objective To investigate the lowest effective pressure in cuff for prevenling endotracheal mucosal injury on rabbit. Methods Twenty-two New Zealand white rabbit were randomly selected. After general anesthesia, an ID 3.5 cm tube catheter was intubated into endotracheal and fulfilled with gas in cuff, and then a T tube was used to connect the pressure spring detector and injector to measure and adjust the pressure inside endotracheal tube cuff. The rabbits were killed after the inner cuff pressure maintaining at preset level for two hours. And the area in endotracheal tissue compressing by cuff was cut for pathological section inspection. Pressure trial was defined as ＂positive＂ if the endotracbeal mucosal injury was observed at pathological section under microscope, and ＂negative＂ if there wasn＇t. The initial pressure in endotracheal tube cuff was 50 cm H2O. If the pressure trial was ＂positive＂ in first rabbit, then the endotracheal tube cuff pressure was decreased 5cm H2Oin the following rabbit, vise versa, until 6 crossover points were observed from ＂negative＂ to ＂positive＂. Results The lowest effective pressure for preventing 50%rabbits from endotracheal mucosal injury （Pre50） was 24. 83 cm H2O （95% injury （Pre95） was 18. 19 cm H2O（ 95% confidence interval： 14. 29-22. 31cm H2O）. Conclusion When maintain the pressure inside the endotraeheal tube cuff in 20 cm H2O it can be effective for preventing the endotracheal mucosal injury on rabbit in the short term.

关 键 词：气管黏膜 气管导管 套囊 压力 

分 类 号：R614[医药卫生—麻醉学]