地塞米松对预防气管插管拔除后气道狭窄的应用价值研究  

Use of dexamethasone for preventing post-extubation airway obstruction in adults: a prospective randomized study

作　　者：余跃天[1] 朱琤[2] 毛恩强[2] 殷荣[1] 李昱洁[1] 杭燕南[1] 皋源[1] 曹建国[1] 

机构地区：[1]上海交通大学医学院附属仁济医院重症监护室,上海200001 [2]上海交通大学医学院附属瑞金医院急诊科,上海200025

出　　处：《内科理论与实践》2014年第2期134-137,共4页Journal of Internal Medicine Concepts & Practice

基　　金：上海市卫生局青年科研基金项目(项目编号:20114Y119)

摘　　要：目的:探讨气管插管拔管前静脉注射地塞米松可否减少患者气道狭窄及再插管的发生率。方法:研究纳入有创机械通气时间>36 h且气囊漏气容量<25%潮气量的患者共162例。将其随机分为3组,拔管前不使用激素治疗的对照组53例、拔管前24 h静脉推注地塞米松5 mg 1次组52例、拔管前24 h每12 h静脉推注地塞米松5 mg2次组57例。比较3组患者拔管后气囊漏气容量、气道喘鸣及再次插管发生率。结果:与对照组相比,注射地塞米松干预组患者气囊漏气容量明显增加(P<0.05)。拔管前24 h内1次和2次地塞米松注射组患者拔管后气道喘鸣发生率均低于对照组(11.5%、8.8%比30.2%,均P<0.001),但该2组间无差异(P>0.05)。3组患者拔管后再次插管率差异无统计学意义(分别为3.8%、3.5%和3.5%,P=0.995)。结论:拔管前1次或多次推注地塞米松均可以减少高危患者拔管后气道狭窄发生率。Objective To investigate whether treatment with corticosteroids could decrease the incidence of post-extubation airway obstruction and reintubation in intensive care unit. Methods One hundred sixty-two patients who wereintubated for 〉36 h with a euff leak volume 〈25% of tidal volume and met weaning criteria were enrolled in this study.Patients were randomized into control group （n=53） not receiving dexamethasone before extubation, 1 injection group（IINJ） （n=52） receiving 1 intravenous injection of dexamethasone 5 mg 24 h before extubation, and 2 injection group（2INJ） （n=57） receiving 2 intravenous injections of dexamethasone 5 mg （q12 h） before extubation. Cuff leak volume wasassessed every 6 h. Post-extubation stridor was confirmed by auscultation. Results The cuff leak volume increased in IINJand 2INJ groups when compared with control group （P〈0.05）. The incidence of post-extubation stridor was lower both inIINJ group and 2INJ group than in control group （11.5%, 8.8% vs 30.2%, all P〈0.001）, and no significant difference wasseen between the two treated groups （P〉0.05）. The incidence of reintubation was not different between the three groups（3.8%, 3.5%, 3.5%, P=0.995）. Conclusions Treatment with a single or multiple injections of dexamethasone couldeffectively reduce the occurrence of post-extubation stridor.

关 键 词：气管插管 咽喉水肿 气囊漏气试验 气囊漏气容量 激素 

分 类 号：R562.12[医药卫生—呼吸系统]