低损伤性气管导管在超长期留置患者中的应用：附1例超长期带管病例报告  

Application of low damage endotracheal intubation in patients undergoing extra long-term endotracheal intubation：a case report

作　　者：王皓[1] 丁宝纯[1] 

机构地区：[1]葫芦岛市中心医院麻醉科,辽宁葫芦岛125000

出　　处：《中华危重病急救医学》2017年第7期644-646,共3页Chinese Critical Care Medicine

摘　　要：目的 探讨低损伤性气管导管对减少套囊相关气管导管并发症及延长带管时间的影响.方法 2015年1月7日,葫芦岛市中心医院收治1例再发蛛网膜下腔出血后呼吸停止患者,立即气管插管、呼吸机辅助通气,在考虑短时间内难以脱机拔管,且家属拒绝气管切开的情况下,应用低损伤性气管导管长期带管.该导管在原有高容量低压套囊的基础上,增设了内层套囊,且内层套囊与气管导管管腔内有侧孔相通.通气期间,套囊压力将会随着气道内压变化自动调整,减少导管套囊对气管黏膜的压迫损伤,提高患者带管的耐受性,延长带管时间.结果 患者于2015年10月12日拔管,共带管279 d,期间未见气管导管相关并发症以及严重吸入性肺炎的发生.结论 低损伤性气管导管能够保证通气过程中套囊内压力随气道压力变化,有效避免套囊压力过高,减少导管相关并发症的发生,在套囊管理方面具有明显优势,特别是对于长期带管患者有较好的临床应用价值.Objective To approach the effect of low damage endotracheal intubation on reducing the occurrence of cuff-related intubation complication and prolonging the intubation time. Methods On January 7th, 2015, 1 patient with respiratory failure after subarachnoid hemorrhage were admitted to Huludao Central Hospital. Immediate endotracheal intubation and ventilator assisted ventilation were performed. When the trachea was difficult to be removed in a short time, and tracheotomy was refused, a low damage endotracheal intubation was used for a long term. On the basis of the original high volume low pressure cuff, this tube was designed for inner cuff, the hole was allowed in the inner cuff to connect with the tube. During the period of ventilation, the cuff pressure changed with airway pressure automatically, therefore it would reduce the compression injury of tracheal mucosa, improve the tolerance of the patients, and prolong the intubation time. Results The patient was removed from the tube on October 12th, 2015 with an intubation day of 279, the intubation-related complications and severe aspiration pneumonia had not been observed during the application of low damage endotracheal intubation. Conclusions Design of this intubation ensured the cuff pressure changes with airway pressure, therefore, it could effectively avoid the cuff pressure become too high, and reduce the occurrence of intubation-related complication. This low damage endotracheal had an evident superiority in the aspects of cuff management. It has a better practical significance, especially for patients with long intubation time.

关 键 词：气管导管 低损伤性 气管插管 套囊压力 组织损伤 

分 类 号：R459.7[医药卫生—急诊医学]