3种形状气囊导管对气囊上滞留物封闭效果的实验研究  

Effect of three endotracheal tube cuff shapes on preventing subglottic secretion leakage:an in-vitro experimental study

作　　者：招春园 黄玲[2] 常龙 韦姿 林景 周春锋[2] Zhao Chunyuan;Huang Ling;Chang Long;Wei Zi;Lin Jing;Zhou Chunfeng(Nursing Department,Cancer Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院护理部,广西南宁530021 [2]广西医科大学附属肿瘤医院重症医学科,广西南宁530021

出　　处：《护理学杂志》2023年第2期9-12,共4页Journal of Nursing Science

基　　金：广西医疗卫生适宜技术开发与推广项目(S2018095)。

摘　　要：目的探讨3种形状气囊导管对不同黏稠度气囊上滞留物的封闭效果,为临床气道管理提供参考。方法用20 mL注射器制作9个气管模型分为3组,每组锥形、柱形、梭形气囊导管各1根。使用持续测压仪予导管气囊充气并维持压力29~30 cmH2O,将机械通气患者气囊上Ⅰ度、Ⅱ度、Ⅲ度滞留物分别注入气囊导管上,观察30、60、120、240、360、480 min气囊上滞留物的渗漏情况。不同黏稠度滞留物每组重复操作10次。结果3种形状气囊导管不同黏稠度滞留物、不同观察时间渗漏量比较,差异有统计学意义(均P<0.05)。结论锥形气囊的封闭效果最好,柱形气囊次之,梭形气囊最差;随着时间延长,各形状气囊导管均会渗漏。建议临床可选用带冲洗式的柱形或锥形气囊导管,及时冲洗及抽吸气囊上滞留物,以预防经口咽途径的呼吸机相关性肺炎的发生。Objective To compare the effect of three endotracheal tube cuff shapes on preventing leakage of subglottic secretions with different viscosity,and to provide reference for airway management.Methods Nine trachea models were made by using 20-mL syringe and divided into three groups,then conical-shaped cuff,cylindrical-shaped cuff,and spindle-shaped cuff tracheal tubes were inserted into the trachea model placed in a vertical position at a fixed height.The cuff of each tube was inflated until reaching a pressure ranging between 29 and 30 cmH2O.Five milliliters of subglottic secretions with different viscosity(watery,thick,and gel-like),which were suctioned from ventilated patients,were poured above the cuff and the volume of fluid leaking around the tube was collected and quantified at 30 min,60 min,120 min,240 min,360 min,and 480 min.The experiments repeated 10 times for each viscosity of the secretions.Results Generalized estimating equations showed that there were significant differences in the volume of leakage,regardless of different viscosity,for three cuff shapes of tubes over time(all P<0.05).Conclusion The conical-shaped cuff tube is the most effective in ensuring appropriate tracheal sealing,followed by the cylindrical-shaped cuff,and the worst is the spindle-shaped cuff.Peri-cuff leak might happen in all tracheal cuff shapes over time.It is recommended that cylindrical-shaped cuff tube with flushing functions or conical-shaped cuff tube should be utilized,in addition to timely flushing and suctioning subglottic secretions,to prevent ventilator-associated pneumonia.

关 键 词：机械通气 气管插管 气囊导管 锥形气囊 柱形气囊 梭形气囊 气囊上滞留物 呼吸机相关性肺炎 

分 类 号：R471[医药卫生—护理学]