不同气囊压力机械通气患者误吸的发生及支气管分泌物胃蛋白酶测定的意义  

Determination of pepsin contents in bronchial secretions for diagnosis of aspiration in patients with mechanical ventilation

作　　者：范丽妫[1] 林小娜[1] 何国鑫[1] 

机构地区：[1]温州医学院附属第三医院肿瘤外科,瑞安325200

出　　处：《浙江医学》2014年第6期479-481,484,共4页Zhejiang Medical Journal

基　　金：瑞安市科技局资助项目(201302029)

摘　　要：目的探讨机械通气患者在不同气囊压力下误吸发生情况及支气管分泌物胃蛋白酶测定的临床意义。方法将79例ICU收治的机械通气患者随机分为高气囊压力(25~30cmH_2O)组(组1)和低气囊压力(20~24cmH_2O组(组2),分别在鼻饲结束后1、2、3h收集支气管分泌物,用放射免疫分析技术测定其胃蛋白酶含量。结果组1患者误吸发生率为12.5%(5/40),组2患者为30.8%(12,39),两组差异有统计学意义(X^2=3.903,P<0.05);组1患者支气管分泌物胃蛋白酶阳性率为7.5%(3/40),组2患者为28.3%(11/39)。两组差异有统计学意义(X^2=5.806,P<0.05)。14例鼻饲后1h支气管分泌物胃蛋白酶检测阳性的患者,标本胃蛋白酶含量测定值与气囊压力值呈负相关(r=0.4,P<0.05)。结论低气囊压力下机械通气的患者更容易发生误吸,支气管分泌物胃蛋白酶测定可用于危重机械通气患者误吸的诊断。Objective To evaluate the pepsin contents in bronchial secretions for diagnosis of aspiration in patients re- ceiving mechanical ventilation. Methods Seventy-nine patients receiving nasogastric tube feeding and mechanical ventilation in ICU were randomly assigned to two groups： group I was ventilated with cuff pressure 25 - 30cmH20 and group II with cuff pres- sure 20- 24cmH2O. The bronchial secretions were collected at lh, 2h and 3h after nasogastric feeding and the pepsin contents were determined by radioimmunoassay. Results The incidence rate of aspiration in groups I and II were 12.5%（5/40） and 30.8% （12/39）, respectively （x2=3.903, P〈0.05）. The positive rates of pepsin contents in bronchial secretions in two groups were 7.5% （3/40） and 28.3%（11/39） respectively （X2=5.806, P〈0.05）. Cuff pressure was negatively correlated with pepsin contents in 14 pa- tients at lh after nasal feeding（r= -0.4, P〈0.05）. Conclusion Patients receiving mechanical ventilation are more likely to aspirate in low cuff pressure, and the determination of pepsin content in bronchial secretions is useful for diagnosis of aspiration for critical patients receiving mechanical ventilation.

关 键 词：气囊压力 胃蛋白酶误吸机械通气 

分 类 号：R459.7[医药卫生—急诊医学]