114-967 测气管内导管套囊压力注射器设计和体外测试.docVIP

测量气管内导管套囊压力的注射器设计和体外验证 Alexander H. Slocum, Jr., SM,* Alexander H. Slocum, Sr., PhD,* and Joan E. Spiegel, MD? *Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge; and ?Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 摘要 气管内插管是在对入院前急救、重症监护病房和手术患者经常实施的一种操作。气管导管的套囊需要充气到一定的压力以防漏气，同时还需保证气管粘膜的血流不受影响。为了能够在给套囊充气的同时测定其压力，我们设计了一种新型的测量压力的注射器，并进行了体外测试。其原型就是一个标准的10 ml聚碳酸酯注射器，其内有柱塞和硅橡胶波纹管，即压力传感原件。使用有限元分析测定并模拟橡胶波纹管的可行性。每个波纹管在不同压力下测压的重复性（压力/偏离），平均标准差在0.3 ~ 1.61 cm（误差为1%-5%）。与无液压力计相比，在30 mm H2O以内，两者之间有很好的线性相关性，Spearman等级0.99（P ＜0.001）。 Abstract Endotracheal intubation is a frequently performed procedure in the prehospital setting,intensive care unit, and for patients undergoing surgery. The endotracheal tube cuff must be inflated to a pressure that prevents air leaks without compromising tracheal mucosal blood flow. For simultaneous endotracheal tube cuff inflation and measurement, we designed and tested a novel pressure-sensing syringe in vitro. The prototype was developed using a standard 10-mL polycarbonate syringe body that houses a plunger and a silicone rubber bellows, the pressure-sensing element. Bellow feasibility was determined and modeled using finite element analysis. Repeatability testing at each pressure measurement for each bellows (pressure versus deflection) was within an average standard deviation of 0.3 cm to 1.61 cm (1%–5% error). Using an aneroid manometer for comparison, there was excellent linear correlation with a Spearman rank of 0.99 ( P＜0.001), up to 30 cm H2O. (Anesth Analg 2012;114:967–71) 自1930年以来，有关气管内导管（ETT）套囊过度充气引起气道并发症的文献就相继发表[1]。在19世纪80年代，内镜研究表明，套囊对气道粘膜的压力在28 ~ 34 cm H2O之间，气道粘膜血流减少，当压力超过50 cm H2O时，气道血流完全被阻断[2]。入院前急救成人患者中ETT套囊过度充气（＞30 cm H2O）的情况超过65%[3]，手术室内超过50%[4]，重症监护病房超过40%[5]。即使在短小手术中（1 ~ 3小时），过度充气的ETT套囊也会导致气道粘膜糜烂，引起患者诉咽痛、咳嗽、痰中带血[6-8]。相反，成人ETT套囊充气不足（ 20 cm H2O），对长期气管插管的患者会导致下呼吸道的细菌繁殖（隐性误吸），可导致呼吸机相关性肺炎。 无论是成人还是小儿，ETT套囊压力均应维持在10 ~ 30 cm