气管导管套囊压力监测对术后插管相关并发症的影响.doc

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 通讯作者:张晓庆，作者单位：1.同济大学附属同济医院；2.复旦大学附属第一人民医院；3.上海市第十人民医院；4.交通大学附属仁济医院 刘健慧1 张晓庆1 龚尉2 傅舒昆3 张马忠 通讯作者:张晓庆， 作者单位：1.同济大学附属同济医院；2.复旦大学附属第一人民医院；3.上海市第十人民医院；4.交通大学附属仁济医院 [摘要] 目的　观察气管导管套囊压力监测与控制对插管后相关并发症的影响。方法 多中心择期全麻患者600例，男女不限，分为未测压组和测压组，记录患者手术时间、带管时间，拔管后24小时随访两组患者相关插管并发症，包括咳嗽、咽痛、血丝痰等。　结果　两组患者间性别、年龄、手术时间及带管时间无明显差异，未测压组术后咽痛及血丝痰的发病率明显高于测压组。两组患者随带管时间延长，咽痛、血丝痰发病率均增高。纤维支气管镜下可见气管粘膜不同程度损伤。 结论 凭经验导管套囊充气，常使囊内压力远高于正常允许值；气管导管套囊压力监测与控制有助于减少术后插管相关并发症。 [关键词] 气管插管；套囊压力；气管粘膜；并发症 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