预充气测压法在人工气道气囊安全管理中的应用  

Pre-inflation manometry in safety management of artificial airway cuff

作　　者：吴彦烁 高鹏[1] 申康康 孟李雪 刘丽霞[1] 尹彦玲[1] WU Yan-shuo;GAO Peng;SHEN Kang-kang;MENG Li-xue;LIU Li-xia;YIN Yan-ling(Department of Intensive Care Unit,The Fourth Hospital of Hebei Medical University,Shijiazhuang,Hebei 050000,China)

机构地区：[1]河北医科大学第四医院重症医学科,河北石家庄050000

出　　处：《中国临床研究》2021年第10期1362-1365,共4页Chinese Journal of Clinical Research

摘　　要：目的探讨预充气测压法对气管导管气囊压力的影响,为临床规范测压流程提供依据。方法研究分为体外研究和临床研究两部分。体外研究:分为常规测压组和预充气测压组,分别对初始值25 cm H_(2)O和30 cm H_(2)O的气囊压力进行常规测压方法和预充气测压方法的测量,两种初始值、两种测压方法分别重复测量50次,共测量200次,观察气囊压力损失值的变化。临床研究:选取2020年6月至8月重症医学科建立人工气道进行机械通气的50例患者做为研究对象,将预充气目标值分为高压组(30 cm H_(2)O)和低压组(25 cm H_(2)O),分别对初始值25 cm H_(2)O和30 cm H_(2)O的气囊压力进行两种预充气目标值方法的测量,每例患者两种初始值、两种测压方法分别测量1次,共4次,50例总计200次,观察气囊压力的变化。结果体外研究:25 cm H_(2)O组常规测压法和预充气测压法导致的气囊压力损失值分别为(8.54±0.89)cm H_(2)O和(0.11±0.28)cm H_(2)O,差异有统计学意义(P<0.01);30 cm H_(2)O组常规测压法和预充气测压法导致的气囊压力损失值分别为(10.18±0.56)cm H_(2)O和(0.06±0.24)cm H_(2)O,差异有统计学意义(P<0.01)。临床研究:同一气囊压力初始值,采用不同的预充气目标值,测得的气囊压力不同,差异有统计学意义(P<0.01)。预充气目标值为30 cm H_(2)O,所测得的气囊压力值在初始值25 cm H_(2)O和30 cm H_(2)O时分别为(27.52±0.76)cm H_(2)O和(29.32±0.62)cm H_(2)O,均在安全压力值(25 cm H_(2)O)以上。结论常规测压法会导致气囊压力明显下降,预充气测压法可以减少测压过程中气囊压力的下降,临床测压时将预充气目标值设为30 cm H_(2)O更安全。Objective To discuss the influences of pre-inflation manometry on endotracheal tube cuff so as to provide reference for the standardization of manometry technique.Methods A clinical and in vitro study was performed.In-vitro study,there were routine manometry group and pre-inflation manometry group,respectively tested for the initial value of pressure cuff at 25 cm H_(2)O and 30 cm H_(2)O,which were repeated for 50 times with a total of 200 times to observe the changes of cuff pressure loss value.In clinical study,50 patients with artificial airway for mechanical ventilation in the Department of Critical Medicine from June to August 2020 were selected,and target values of pressure cuff of 25 cm H_(2)O(low pressure)and 30 cm H_(2)O(high pressure)were set and measured respectively by routine manometry and pre-inflation manometry in each patient(total 200 times in 50 cases)to observe the influence of different pre-inflation values on cuff pressure.Results In-vitro study,the cuff pressure loss values were(8.54±0.89)cm H_(2)O by routine manometry and(0.11±0.28)cm H_(2)O by pre-inflation manometry at 25 cm H_(2)O and were(10.18±0.56)cm H_(2)O by routine manometry and(0.06±0.24)cm H_(2)O by pre-inflation manometry at 30 cm H_(2)O,and there were statistical differences in them(P<0.01).In clinical study,there were significant differences in cuff pressure at the same target values by different manometry(P<0.01).When the target value of pre-inflation was 30 cm H_(2)O,the measured cuff pressure values were(27.52±0.76)cm H_(2)O and(29.32±0.62)cm H_(2)O at the initial value of 25 cm H_(2)O and 30 cm H_(2)O respectively,both of which were above the safety pressure value of 25 cm H_(2)O.Conclusions The routine manometry can lead to the significant decrease of cuff pressure.The pre-inflation manometry can reduce the cuff pressure drop.It is safer to set the pre-inflation target value to 30 cm H_(2)O in clinical pressur measurement.

关 键 词：测压法 人工气道 气囊压力 安全管理 

分 类 号：R459.6[医药卫生—治疗学]