持续气囊压力监测在先天性心脏病术后气管插管患儿中的应用  

Continuous balloon pressure monitoring in children with tracheal intubation after surgical repair of congenital heart disease

作　　者：孙斌 张悦玥 陈琳 朱丽敏[1] Sun Bin;Zhang Yueyue;Chen Lin;Zhu Limin(Cardiac Intensive Care Unit,Department of Cardiothoracic Surgery,Shanghai Children′s Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科监护室,200127

出　　处：《中国小儿急救医学》2023年第7期536-540,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨持续气囊压力监测仪在先天性心脏病术后气管插管患儿中的应用效果。方法选择先天性心脏病术后入住监护室的患儿,采用随机数字表将患儿分为两组,在各项治疗原则相同的情况下,试验组采用持续自动气囊压力监测仪对气囊压力进行管理,对照组采用手动气囊压力测量仪对气囊压力进行管理,比较两种方法的临床结果。结果共有84例患儿入选研究,其中试验组40例,对照组44例。两组患儿在年龄、性别、插管深度、插管型号方面比较差异无统计学意义(均P>0.05)。试验组和对照组的呼吸机漏气率分别为17.5%和20.5%,两组误吸率分别为0和6.8%,差异均无统计学意义(均P>0.05)。试验组的机械通气时间大于对照组[中位呼吸机时间44.0(41.7,73.5)h比43.0(38.9,60.5)h,P=0.024],但气囊压力异常率(10.0%比81.8%,P<0.001)、撤机后喉水肿发生率(2.5%比18.2%,P=0.031)以及发声困难发生率(7.5%比25.0%,P=0.032)均低于对照组,差异有统计学意义。结论持续气囊压力监测能自动保持气囊压力处于正常范围,减少人工气道相关的并发症,对儿童气道的维护有积极作用。Objective To investigate the effect of continuous balloon pressure monitor in children with postoperative tracheal intubation after congenital heart disease(CHD).Methods Children admitted to the intensive care unit after CHD surgery were selected and divided into two groups using a random number table.Under the same treatment principles,the intervention group used a continuous balloon pressure monitor to manage the balloon pressure,and the control group used a manual balloon pressure meter.The clinical outcomes of two groups were compared.Results A total of 84 children were enrolled,including 40 in intervention group and 44 in control group.There were no significant differences in age,sex,intubation depth and intubation type between two groups(all P>0.05).The rates of ventilator leakage in the intervention and control groups were 17.5%and 20.5%,respectively,and the rates of misaspiration in two groups were 0 and 6.8%,respectively,with no statistically significant differences(all P>0.05).The duration of mechanical ventilation in intervention group was longer than that in control group[median ventilator time 44.0(41.7,73.5)h vs.43.0(38.9,60.5)h,P=0.024],but the rates of abnormal balloon pressure(10.0%vs.81.8%,P<0.001),the rate of laryngeal edema after withdrawal(2.5%vs.18.2%,P=0.031)and the rate of vocal difficulties(7.5%vs.25.0%,P=0.032)were lower than those in control group,and the differences were statistically significant.Conclusion Continuous balloon pressure monitoring can automatically maintain balloon pressure in the normal range,reduce complications associated with artificial airways,and have a positive effect on the maintenance of the airway in children.

关 键 词：儿童 先天性心脏病 人工气道 气囊压力 

分 类 号：R726.5[医药卫生—儿科]