应用不同型号气管导管行气管插管对颅脑损伤患者拔管后误吸的影响研究  

Influence of endotracheal intubation type on aspiration after extubation in patients with traumatic brain injury

作　　者：李丽青 董子倍 张亚琴 Li Liqing;Dong Zibei;Zhang Yaqing(Department of Intensive Care Medicine,ICU 2,Zhenzhou Central Hospital Affiliated to Zhengzhou University,Zhenghzou 450007,China;Department of Nursing,Zhenzhou Central Hospital Affiliated to Zhengzhou University,Zhenghzou 450007,China)

机构地区：[1]郑州大学附属郑州中心医院重症医学科重症监护室,郑州450007 [2]郑州大学附属郑州中心医院护理部,郑州450007

出　　处：《河南外科学杂志》2024年第1期24-26,共3页Henan Journal of Surgery

基　　金：河南省高等学校重点科研项目计划(22B320020)。

摘　　要：目的比较应用不同型号气管导管行气管插管(ETT)对颅脑损伤患者拔管后误吸的影响。方法前瞻性纳入2020-05—2021-06于郑州某三甲医院ICU收治的行ETT的颅脑损伤患者(行ETT已超过48 h)。插管24 h内按气管导管型号分为A组(≤7.0 mm)、B组(7.5 mm)和C组(≥8.0 mm)。拔管后6 h内,以纤维支气管镜检查所见,并取口腔和气管标本的量化值α淀粉酶及胃蛋白酶A作为生物学误吸标本,统计误吸发生情况。结果共纳入150例患者,每组50例。3组患者的临床资料差异无统计学意义(P>0.05)。拔管6 h后患者的α淀粉酶水平及胃蛋白酶A浓度为A组<B组<C组,差异有统计学意义(P<0.05);本研究所有患者的胃蛋白酶A均≤200 ng/mL,α淀粉酶≤3314UI/L。纤维支气管镜及生物标记物阳性率均为A组<B组<C组,差异有统计学意义(P<0.05)。纤维支气管镜阳性率≤生物学标本检出阳性率,各组胃蛋白酶检出阳性率均>α淀粉酶,差异有统计学意义(P<0.05)。结论对颅脑损伤患者应用较大型号气管导管行ETT与拔管后发生误吸风险相关;使用较小型号的气管导管可降低拔管后误吸的风险。Objective To determine whether the diagnosis of accidental suction after extraction of a TBI patient is related to a changeable risk factor,the trachea intubation model.Methods From January 2021 to January 2023,150 experimental subjects were selected and divided into three groups A,B and C according to the endotracheal intubation model within 24 hours of intubation and registered,and within 6 hours after extubation,all patients underwent fiberoptic bronchoscopy,and the quantitative values of oral and tracheal specimensα-amylase and pepsin A were used as aspiration biological samples.Results A total of 150 patients with 50 patients in each group were included.There was no significant difference in clinical data between the three groups(P>0.05).Theα-amylase level and pepsin A concentration of the patients were statistically significant in group A<group B<group C after 6 hours of extubation(P<0.05),and the pepsin A≤of all patients in this study was 200 ng/mL and theα-amylase≤was 3314 UI/L.The positive rates of flexible bronchoscopy and biomarkers were both in group A<group B<group C,and the difference was statistically significant(P<0.05).The positive rate of fiber bronchoscopy≤the positive rate of biological specimens,and the positive rate of pepsin in each group>α-amylase.The difference was statistically significant(P<0.05).Conclusion The use of a larger endotracheal tube for ETT in patients with head injury is associated with the risk of aspiration after extubation.The use of a smaller model of endotracheal tube reduces the risk of aspiration after extubation.

关 键 词：创伤性颅脑损伤 误吸 气管内插管 

分 类 号：R459.6[医药卫生—治疗学]