气囊压力表间断测量气囊压力值偏差的实验研究  

Experimental study of the monitoring bias of pressure in intubation balloon using handheld pressure gauge

作　　者：林艳侠[1] 林丹[1] 陈碧群[1] 纪超[1] 袁从丽 王宝春[1] 

机构地区：[1]厦门大学附属中山医院重症医学科,福建361004

出　　处：《中华危重病急救医学》2014年第5期347-350,共4页Chinese Critical Care Medicine

基　　金：福建省厦门市科技计划项目（3502Z20124056）

摘　　要：目的 探讨气囊压力表间断测量人工气道气囊压力时,测量值与实际值之间是否存在偏差、偏差来源和偏差大小,为气囊压力表的正确使用提供参考.方法 在实验室体外实验中,采用专用手持气囊压力表通过三通开关与人工气道气囊充气管线单向阀连接,通过三通的开关控制,测量气囊压力,得到测量值偏差后进行临床试验加以验证.研究对象为建立人工气道需行气囊压力监测的成人患者.结果 在实验室经过132次测量发现,手持压力表本身会造成气囊压力下降,称之为固有损失;充气值[（30.000±0.000） cmH2O,1 cmH2O=0.098 kPa]和测量值[（26.072±0.291）cmH2O]之间存在明显偏差,平均为（3.928±0.291）cmH2O（t=155.273,P=0.000）;经过214次测量发现,充气管线单向阀在与压力表断开和连接的过程中造成气囊压力下降,称之为误差损失;充气值[（30.000±0.000） cmH2O]和测量值[（28.804±0.954） cmH2O]之间存在偏差,平均为（1.196±0.954） cmH2O（t=18.348,P=0.000）.临床经过21 1次验证试验得到固有损失和误差损失两者之和,充气值[（30.000±0.000） cmH2O]和测量值[（24.730±2.583） cmH2O]之间同样存在偏差（即测量偏差）,其值为（5.270±2.583） cmH2O（t=29.632,P=0.000）.结论 使用气囊压力表进行间断测量气囊压力时,气囊原有的实际压力应为测量值与偏差值之和,且在连接前应先进行声门下吸引,以防止气囊上方分泌物因气囊体积缩小而滑向气道深部而引起误吸,并将气囊压力维持在30 cmH2O.Objective To explore the bias between the real pressure and the measured values when handheld pressure gauge （HPG） was used to monitor intermittently the pressure in the intubation balloon,so as to provide some measures for the correct use of HPG.Methods In the first part of the study,HPG was used to measure the pressure with the balloon connected with a three-way tube with which to control the inflation and deflation in a laboratory to measure the pressure in the air bag.After gaining the deviation in this in vitro experiment,it was tested and verified in vivo in adult patients undergoing endotracheal intubation.Results After 132 times of measurements,it was found that measurement with a HPG might result in an ＂inherent loss＂ （3.928 ± 0.291） cmH2O （1 cmH2O=0.098 kPa,t =155.273,P =0.000） between inflation value [（30.000 ± 0.000） cmH2O] and measured value [（26.072 ± 0.291） cmH2O].In addition,after 214 times repeated measurements,the pressure ＂loss＂ during disconnection of the gauge was as high as （1.196 ± 0.954） cmH2O （t=18.348,P=0.000） between filled values [（30.000 ± 0.000） cmH2O] and measured values [（28.804 ± 0.954） cmH2O] and it was named as ＂error loss＂.At last,the total error was verified by clinical test,and it was （5.270 ± 2.583） cmH2O （t=29.632,P=0.000） between pressure of filled value [（30.000 ± 0.000） cmH2O] and measured value [（24.730 ± 2.583） cmH2O].Conclusions When the balloon pressure was Monitored intermittently with HPG,the real value should be the measured value plus the ＂error＂.In addition,subglottic aspiration should be done before the connection of the balloon to the gauge to prevent the secretions on the cuff falls into the deeper airway,and to maintain the cuff pressure at 30 cmH2O.

关 键 词：气囊压力管理 间断监测 偏差 实验研究 

分 类 号：R459.7[医药卫生—急诊医学]