气管导管套囊充气前后气管横径变化值与套囊压的相关性  

Correlation between tracheal transverse diameter s variation during endotracheal tube cuff inflation and the cuff pressure

作　　者：施洁 杨歆璐 杨成伟 章蔚 方军 王胜[3] SHI Jie;YANG Xinlu;YANG Chengwei;ZHANG Wei;FANG Jun;WANG Sheng(Graduate School,Wannan Medical College,Wuhu 241002,China)

机构地区：[1]皖南医学院研究生学院,安徽省芜湖市241002 [2]中国科学技术大学附属第一医院麻醉科 [3]中国科学技术大学附属第一医院(安徽省立医院)麻醉科

出　　处：《临床麻醉学杂志》2021年第11期1177-1181,共5页Journal of Clinical Anesthesiology

摘　　要：目的探讨超声测量气管导管(ETT)套囊充气前后的气管横径变化值(ΔTD)与ETT套囊压(CP_(ETT))的相关性。方法选择2020年6月—2021年8月行气管插管全身麻醉的男性患者,年龄18~60岁,BMI 18~25 kg/m^(2),ASAⅠ至Ⅲ级。研究分为两个部分。第1部分拟招募90例符合纳入标准的患者,用指压法进行ETT套囊充气,分别在充气前后用超声测量胸骨上窝水平的气管横径,计算ΔTD。然后用压力表测量套囊压力(CP_(ETT))。采用受试者工作特征(ROC)曲线求取ΔTD截断值并分析其预测效能。第2部分拟招募46例患者,按照ETT套囊充气方法随机分为指压组和超声组,每组23例。指压组使用指压法为套囊充气,超声组使用超声结合ΔTD截断值指导套囊充气。两组充气后均用压力表测量CP_(ETT)。结果当CP_(ETT)不高于110 cmH_(2)O时,CP_(ETT)与ΔTD呈明显正相关(r=0.78,P<0.05)。ΔTD的ROC曲线下面积(AUC)为0.85,ΔTD截断值为1.25 mm,敏感性为70.5%,特异性为84.2%。与指压组比较,超声组正常CP_(ETT)占比明显升高(P<0.05)。结论当CP_(ETT)不高于110 cmH_(2)O时,CP_(ETT)与ΔTD呈明显正相关;超声法测量ΔTD指导ETT套囊充气明显优于指压法。Objective To investigate the correlation between the tracheal transverse diameter s variation(ΔTD)during endotracheal tube(ETT)cuff inflation measured under ultrasound and the ETT cuff pressure(CP_(ETT))and its guiding significance to ETT cuff inflation.Methods Male patients,received endotracheal intubation under general anesthesia from June 2020 to August 2021,aged 18-60 years,BMI 18-25 kg/m^(2),ASA physical statusⅠ-Ⅲ,were selected.This study was consisted of two sections.In the first section,90 patients were enrolled.ETT cuff was inflated by palpation.The tracheal transverse diameter at the level of suprasternal fossa was measured under ultrasound before and after inflation.AndΔTD was calculated.Then the ETT cuff pressure(CP_(ETT))was measured by a manometer.After that,the cut-off value ofΔTD was obtained by receiver operating characteristic(ROC)curve and its prediction efficiency was analyzed.In the second section,46 patients were recruited and randomized into two groups according to the inflation method:the palpation group and the ultrasound group,with 23 patients in each.In the palpation group,the ETT cuff was inflated using palpation method.And in the ultrasound group,the cuff inflation was guided under ultrasound with the cut-off value ofΔTD.All of the CP_(ETT)were measured with a manometer after inflation.Results When the CP_(ETT)was within 110 cmH_(2)O,the CP_(ETT)had a significantly positive linear correlation withΔTD(r=0.78,P<0.05).The area under ROC curve(AUC)ofΔTD was 0.85.The cut-off value ofΔTD was 1.25 mm,with a sensitivity of 70.5%,and a specificity of 84.2%.Compared with the palpation group,the ratio of suitable CP_(ETT)in the ultrasound group was significantly increased(P<0.05).And the ratio of excessive CP_(ETT)was significantly decreased(P<0.05).Conclusion When the CP_(ETT)is within 110 cmH_(2)O,it has a significantly positively linear correlation withΔTD.Compared with the palpation method,theΔTD measured under ultrasound can better guide the inflation of ETT cuff.

关 键 词：气道管理 气管导管套囊压力 气管插管 气管横径 超声 

分 类 号：R614[医药卫生—麻醉学]