注气试验在食道测压管定位中的应用  

Application of injection test in confirming the ideal position of esophageal balloon catheter

作　　者：陈晗[1,2] 徐明[1] 杨燕琳[3] 何璇[1] 周建新[1] Chen Han Xu Ming Yang Yanlin He Xuan Zhou Jianxin(Department of Critical Care Medicine, Beifing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China Third Department of Critical Care Medicine, Fufian Provincial Clinical College, Fufian Medical University, Fuzhou 350001, Fufian, Chin Department of Critical Care Medicine, Beijing Electric Power Hospital, Beijing 100073, China)

机构地区：[1]首都医科大学附属北京天坛医院重症医学科,北京100050 [2]福建医科大学省立临床医学院重症医学三科,福建福州350001 [3]北京电力医院重症医学科,100073

出　　处：《中华危重病急救医学》2017年第9期783-788,共6页Chinese Critical Care Medicine

基　　金：福建省卫生和计划生育委员会青年科研课题（2017-2-2）

摘　　要：目的 评价注气试验用于食道测压管定位的安全性和临床可行性.方法 采用前瞻性研究方法,选择2015年5月至2017年3月首都医科大学附属北京天坛医院综合重症加强治疗病房（ICU）收治的气管插管机械通气患者.将食道测压管进行改造,以实施注气试验.在逐步回撤导管过程中通过注气试验寻找出现食道压（Pes）扰动波的位置,定义此时气囊恰好进入食道内.以此位置为0 cm,分别在＋15、＋10、＋5、0、-5、-10和-15 cm处进行呼气末阻断,分别在自主呼吸和被动通气的状态下测量Pes和气道压（Paw）的变化幅度（ΔPes、ΔPaw）及其比值.结果 研究期间共纳入20例患者,15例患者完成了自主呼吸和被动通气,2例患者仅完成了自主呼吸,3例患者仅完成了被动通气.① 所有患者均可通过注气试验引出扰动波,被动通气时出现扰动波的深度大于自主呼吸（cm：42.4±3.8比41.8±3.3）,但差异无统计学意义（P=0.132）.研究过程中未发生与注气试验相关的不良事件.② 无论是自主呼吸还是被动通气,随着导管逐步回撤,Pes均逐渐升高,在＋5 cm处达到最高水平,之后逐渐降低.自主呼吸时,0、-5、-10 cm处ΔPes/ΔPaw比值处于理想范围（0.8~1.2）,以0 cm处ΔPes/ΔPaw比值最接近1（0.98±0.15）,-15 cm处ΔPes/ΔPaw比值（0.66±0.26）明显低于0 cm处（P〈0.05）;被动通气时,-5 cm和-10 cm处ΔPes/ΔPaw比值处于理想范围,以-10 cm处ΔPes/ΔPaw比值最接近1（0.94±0.12）,0 cm和-5 cm处ΔPes/ΔPaw比值明显高于-10 cm处（分别为1.43±0.31、1.12±0.14）,而-15 cm处ΔPes/ΔPaw比值（0.68±0.23）明显低于-10 cm处（均P〈0.01）.结论 通过注气试验可快速简便地找到理想的食道测压管位置,且具有安全性和临床可行性.临床试验注册美国临床试验数据库（Clinical Trials）,NCT02446938.Objective To evaluate the safety and feasibility of injection test which is used to locate esophageal balloon catheter.Methods A prospective study was conducted. The patients undergoing invasive mechanical ventilation （MV） admitted to general intensive care unit （ICU） of Beijing Tiantan Hospital Affiliated to Capital Medical University from May 2015 and March 2017 were enrolled. The commercially available esophageal balloon catheter was modified to perform injection test. The catheter was withdrawn step by step and the injection test was repeated until the presence disturbance wave presented, which indicated that the balloon had just entered the esophagus. The position where disturbance wave appears was named 0 cm. End-expiratory occlusions were performed at the positions of＋15,＋10,＋5, 0, -5, -10 and -15 cm, respectively, and the changes of esophageal pressure （Pes） and airway pressures （Paw） were measured in the spontaneous breathing and passive ventilation, and the ratio between the changes （ΔPes/ΔPaw） was calculated.Results A total of 20 patients were enrolled, of which 15 patients finished both the spontaneous and the passive ventilation parts, and 2 patients finished only the spontaneous part and 3 patients finished only passive part. ① Disturbance waves could be induced by injection test in all patients. The average depth of disturbance wave in spontaneous breathing was deeper than that in passive ventilation （cm： 42.4±3.8 vs. 41.8±3.3）, but there was no significant difference between the two ventilation settings （P = 0.132）. No adverse events occurred during the study period. ② Pes increased with the stepwise withdraw of esophageal catheter, reached the maximal value at＋5 cm, and then decreased when the catheter was further withdrawn, no matter in the spontaneous or the passive ventilation. In spontaneous breathing, the ΔPes/ΔPaw was within the ideal range （0.8-1.2） at the positions of 0, -5 and -10 cm. The ΔPes/ΔPaw was closest to unity at the position

关 键 词：食道压 气道压 阻断试验 呼吸衰竭 

分 类 号：R459.7[医药卫生—急诊医学]