对术后插管相关并发症的影响.docVIP

气管导管套囊压力与术后插管并发症相关性分析 ——多中心调查研究 ( 刘健慧1 张晓庆1 龚尉2 傅舒昆3 张马忠4 [摘要] 目的　方法　结果　结论关键词 The Correlation Analysis of endotracheal cuff pressure and immediate complications of endotracheal intubation: a double blind, multiple-center study. LIU Jianhui, ZHANG Xiaoqing, GONG Wei, Fu Shukun, Zhang Mazhong. Corresponding author: ZHANG Xiaoqing [Abstract] Objective To investigate the effect of cuff pressure measure and control on intubation complications postoperatively. Methods 600 patients with general anesthesia regardless of gender ,were divided into two groups control group and cuff pressure measure group. Operation time, intubation time were recorded, complications such as cough, sangia, and sputum with blood were also recorded within 24 hours postoperatively. Results The two groups were comparable with respect to gender, age, operation time, and intubation time. The incidence of angia , sprtum with blood in cuff pressure measure group was obviously higher than those in control group. The incidence of angia and sprtum with blood increased significantly with the prolonging of intubation time in both groups. Tracheal mucosa injury with different degree was seen under fiber bronchoscopy. Conclusions The cuff pressure by experience was higher than the permitted value. The cuff pressure measure and control contributes to decrease the complications related to endotracheal intubation. [Key words] Endotracheal intubation; Cuff pressure; Tracheal mucosa; Complications 气管插管、气管切开时导管套囊充气不足可致漏气从而影响有效通气，而气囊压力过高可影响气管粘膜血供，导致气管壁局部缺血，甚至引起溃疡出血、坏死甚或气管食管瘘。因此，为防止套囊造成气管粘膜损伤，应常规测定套囊压力。本文通过多中心、双盲法调查研究，探讨套囊压力监测及控制在减少术后插管相关并发症的重要性。 1资料与方法 1.1 一般资料 随机选择全麻手术患者600例，分别来自本市四家三级甲等医院，为减少人为因素影响，对患者未作任何限制。其中男性254例，女性346例，ASA分级级，年龄岁0.1g、阿托品0.5mg或东莨菪碱0.3mg。患者入室后行常规心电监护，麻醉诱导以咪达唑仑3~5mg、依托咪酯0.3mg/kg、阿曲库铵0.6mg/kg和芬太尼4μg/kg，按患者具体情况选择恰当气管导管（ID7.0～8.0mm），气管插管后接麻醉机行机械通气，调整呼吸参数使ETCO2在30~35mmHg。麻醉维持以丙泊酚2~4mg/kg·h静脉输注，辅