气管插管患儿围术期套囊压力管理研究现状  

Current research status on perioperative cuff pressure management in children with endotracheal intubation

作　　者：杨佳麒 罗楷 杨磊[1] 李羽[1] Yang Jiaqi;Luo Kai;Yang Lei;Li Yu(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu 61004l,Sichuan Province,China)

机构地区：[1]四川大学华西医院麻醉手术中心,成都610041

出　　处：《中华妇幼临床医学杂志（电子版）》2023年第2期132-138,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：四川省科学技术厅重点研发项目(2023YFS0139)。

摘　　要：气管插管术(endotracheal intubation)是目前临床管理儿童呼吸道最可靠的技术,其中气管导管套囊压力管理,作为呼吸道管理的重要组成部分,尚未引起临床麻醉科医师的足够重视,尤其在围术期全身麻醉及接受机械通气治疗重症患儿中。气管导管套囊充气的目的,主要保证围术期及机械通气治疗患儿有效通气和密封气管,气管导管套囊充气不足,除引起患儿通气量下降外,还存在导致患儿误吸的风险;相反,过度充气,则可导致患儿气管黏膜缺血、坏死,严重者甚至危及患儿生命安全。目前,国内外推荐成年患者气管导管套囊压力为20~30cmH_(2)0(1cmH_(2)0=0.0981kPa),然而由于医学伦理学限制,涉及患儿生理、解剖等特殊性,多数对于气管导管套囊压力数据的研究结果,均来源于成年患者。笔者拟对患儿围术期带套囊与无套囊气管导管的应用、气管导管套囊充气技术、气管导管套囊压力的影响因素、套囊压力变化,对术后患儿呼吸道并发症影响的最新研究现状进行阐述,旨在为提高患儿临床麻醉及机械通气治疗质量提供客观证据。Endotracheal intubation is one of the most important techniques to manage airway in pediatrics.However,the variations of endotracheal cuff pressure were rarely noticed by anesthesiologists,especially intubated critically ill children.The aim of endotracheal cuff inflation is to maintain occlusion of airway and effectiveness of ventilation.Insufficient cuff inflation can lead to aspiration and inadequate ventilation.And overinflation of cuff causes ischemia and necrosis of tracheal mucosa yet.According to previous guidelines,the recommending endotracheal cuff pressure was 20-30 cmH_(2)O(1 cmH_(2)O=0.0981 kPa)in adults.However,up to now researches on appropriate cuff pressure were limited in children due to ethical problem as well as their characteristics,of physiology and anatomy.This article reviews current evidence of different endotracheal tube types,inflation technology,influencing factors of cuff pressure,and postoperative intubated-associated complications in children with the aim of providing the evidence for improving the quality of mechanical ventilation and clinical techniques in children.

关 键 词：插管法 气管内 气道管理 套囊压力监测 麻醉 全身 机械通气 呼吸道黏膜损伤 儿童 

分 类 号：R726.1[医药卫生—儿科]