气囊漏气测试指导脱机拔管在行机械通气气管插管患者中的应用

摘要

目的:探讨气囊漏气测试(CLT)指导脱机拔管在行机械通气气管插管患者中的应用.方法:选取行机械通气的64例气管插管患者,根据CLT漏气量情况将其分为CLT阴性组(47例)和CLT阳性组(17例).采用CLT指导脱机拔管,比较两组患者体质量指数(BMI)、急性生理与慢性健康评估(APACHE-Ⅱ)评分等基本情况、插管相关情况、血气分析指标、生命体征以及插管拔除后上气道阻塞(UAO)发生率和再插管率,并分析影响UAO发生的危险因素.结果:CLT阴性组患者BMI显著小于CLT阳性组患者,差异有统计学意义(t=2.44,P＜0.05);CLT阴性组患者UAO发生率为6.38％,再插管率为2.13％,明显低于CLT阳性组患者的UAO发生率(35.29％)和再插管率(17.65％),差异有统计学意义(x2=8.63,x2=5.13;P＜0.05);UAO患者与非UAO患者BMI、APACHE-Ⅱ评分、插管时间、气囊压力、动脉血氧分压(PaO2)和血氧饱和度(SpO2)等指标进行组间比较差异有统计学意义(t=5.63,t=2.65,t=4.27,t=3.35,t=2.37,t=2.66;P＜0.05);经Logistic回归分析,BMI、APACHE-Ⅱ评分、插管时间以及气囊压力是影响拔管后UAO发生的危险因素.结论:气管插管行机械通气患者采用CLT指导脱机拔管,可有效降低再插管率,对于肥胖、APACHE-Ⅱ评分较高、插管时间较长以及气囊压力较大的患者,UAO发生风险较大,拔管前应减少再插管次数,全面评估患者生理状态,降低UAO发生率.%Objective: To explore the application of the cuff-leak test(CLT)guiding offline extubation in patients with tracheal intubation of mechanical ventilation.Methods: 64 patients with tracheal intubation who underwent mechanical ventilation were divided into CLT-negative group(47 cases)and CLT-positive group(17 cases)according to leakage situation of CLT.The CLT guiding offline extubation were adopted in the study and some basic situations,such as body mass index(BMI),APACHE-Ⅱ and so on,of the two groups were compared.And the relative situation of intubation,blood gas analysis index,vital signs,the occurrence rate of upper airway obstruction(UAO)post removing intubation and re-intubation rate between the two groups also were compared,and then the risk factors of influencing UAO were further analyzed.Results: The BMI of CLT-negative group was significantly smaller than that of CLT-positive group(t=2.44,P＜0.05).The occurrence rate of UAO and re-intubation rate of CLT-negative group(6.38％and 2.13％)were significantly lower than that of CLT-positive group(35.29％and 17.65％)(x2=8.63,x2=5.13,P＜0.05),respectively.The differences of BMI,APACHE-Ⅱ scores,intubation time,air sac pressure,PaO2and SpO2between patients with UAO and patients without UAO were significant(t=5.63,t=2.65,t=4.27,t=3.35,t=2.37,t=2.66,P＜0.05).The results of Logistic regression analysis showed that the BMI,APACHEⅡ score,intubation time,air sac pressure were independent risk factors for occurring UAO post extubation.Conclusion: The CLT guiding offline extubation in patient with tracheal intubation of mechanical ventilation can effectively reduce the re-intubation rate.For these patients with obesity,high APACHE-Ⅱ score,long intubation time and big air sac pressure,the risk of occurring UAO is higher.Therefore,the number of intubation pre extubation should be reduced for them,and their physiological status should be comprehensively assessed so as to decrease the occurrence rate of UAO.