比较研究气管导管套囊不同充气方法对导管套囊压与气管黏膜损伤的影响

摘要

Objective To investigate the effect of different methods of endotracheal catheter cuff inflation on cuff pressure and tracheal mucosal damage postoperatively .Methods 120 patients undergoing gynecological tumorectomy as a selective operation with general anesthesia were randomly divided into 3 groups with different methods of cuff inflation :finger kneading method ,spe-cialized cuff pressure meter ,and minimum closing volume method .The cuff pressure were measured by specialized cuff pressure gauge and the tracheal mucous membrane was examined by fibrolaryngoscope at the time of withdrawal of endotracheal tube .The cuff pressure and the tracheal mucosal change with different cuff inflation methods were compared .Results The average cuff pres-sure with finger kneading method(49 ± 11 .8 cm H2 O)was obviously higher than specialized cuff pressure meter group (27 ± 1 .5 cm H2O)and minimum closing volume method group(25 ± 2 .1 cm H2O) .The incidence of tracheal mucosal damage was obviously higher in the group with finger kneading method(87 .5% ) than other groups(20 .0% and 15 .0% respectively) .There were no obvi-ous differences in the incidence of tracheal mucosal damage between the rest two groups (P>0 .05) .Conclusion The cuff pressure in the finger kneading method was higher than the permitted value and it make the incidence of tracheal mucosal damage increase . The cuff inflation with specialized cuff pressure meter and minimum closing volume method can make the cuff pressure properly a-mong the permitted value and decrease the complications related to endotracheal intubation .%目的：观察气管导管套囊不同充气方法对导管套囊压与气管黏膜损伤的影响。方法选择择期全身麻醉下行妇科肿瘤切除术患者120例，随机分为3组，分别用指感法、测压法、最小封闭压力法给气管导管套囊充气，用专用套囊测压表分别测定3种方法给气管导管套囊充气后的套囊压力。术毕在患者苏醒拔出气管导管过程中，用可视纤维喉镜观察患者气管黏膜的改变，比较不同充气方法的导管套囊压力与气管黏膜损伤的差异。结果指感法组平均套囊压（49±11．8 cm H2 O ）明显高于测压法组（27±1．5cm H2O）和最小封闭压力法组（25±2．1cm H2O），测压法和最小封闭压力法两组间平均套囊压比较差异无统计学意义（ P＞0．05）。指感法组气管黏膜损伤发生率（87．5％）较测压法组（20．0％）和最小封闭压力法组（15．0％）明显升高，测压法和最小封闭压力法两组间患者气管黏膜损伤的发生率比较差异无统计学意义（P＞0．05）。结论凭经验用指感法给导管套囊充气，易使套囊内压力远高于正常允许值，发生气管黏膜损伤风险高。采用测压法或最小封闭压力法给导管套囊充气，套囊压力基本控制在正常允许值范围内，2种方法均可降低患者气管黏膜损伤风险。