CAJ | 학술논문

目的：探讨机械通气患者在不同气囊压力下误吸发生情况及支气管分泌物胃蛋白酶测定的临床意义。方法将79例ICU收治的机械通气患者随机分为高气囊压力（25～30cmH2O）组（组1）和低气囊压力（20～24cmH2O）组（组2），分别在鼻饲结束后1、2、3h收集支气管分泌物，用放射免疫分析技术测定其胃蛋白酶含量。结果组1患者误吸发生率为12.5%（5/40），组2患者为30.8%（12/39），两组差异有统计学意义（χ2=3.903，P＜0.05）；组1患者支气管分泌物胃蛋白酶阳性率为7.5%（3/40），组2患者为28.3%（11/39），两组差异有统计学意义（χ2=5.806，P＜0.05）。14例鼻饲后1h支气管分泌物胃蛋白酶检测阳性的患者，标本胃蛋白酶含量测定值与气囊压力值呈负相关（r＝0.4，P＜0.05）。结论低气囊压力下机械通气的患者更容易发生误吸，支气管分泌物胃蛋白酶测定可用于危重机械通气患者误吸的诊断。
목적：탐토궤계통기환자재불동기낭압력하오흡발생정황급지기관분비물위단백매측정적림상의의。방법장79례ICU수치적궤계통기환자수궤분위고기낭압력（25～30cmH2O）조（조1）화저기낭압력（20～24cmH2O）조（조2），분별재비사결속후1、2、3h수집지기관분비물，용방사면역분석기술측정기위단백매함량。결과조1환자오흡발생솔위12.5%（5/40），조2환자위30.8%（12/39），량조차이유통계학의의（χ2=3.903，P＜0.05）；조1환자지기관분비물위단백매양성솔위7.5%（3/40），조2환자위28.3%（11/39），량조차이유통계학의의（χ2=5.806，P＜0.05）。14례비사후1h지기관분비물위단백매검측양성적환자，표본위단백매함량측정치여기낭압력치정부상관（r＝0.4，P＜0.05）。결론저기낭압력하궤계통기적환자경용역발생오흡，지기관분비물위단백매측정가용우위중궤계통기환자오흡적진단。
Objective To evaluate the pepsin contents in bronchial secretions for diagnosis of aspiration in patients re-ceiving mechanical ventilation. Methods Seventy- nine patients receiving nasogastric tube feeding and mechanical ventilation in ICU were randomly assigned to two groups:group I was ventilated with cuff pressure 25~30cmH2O and group II with cuff pres-sure 20~24cmH2O. The bronchial secretions were collected at 1h, 2h and 3h after nasogastric feeding and the pepsin contents were determined by radioimmunoassay. Results The incidence rate of aspiration in groups I and II were 12.5%(5/40) and 30.8%(12/39), respectively (χ2=3.903, P<0.05). The positive rates of pepsin contents in bronchial secretions in two groups were 7.5%(3/40) and 28.3%(11/39) respectively (χ2=5.806, P<0.05). Cuff pressure was negatively correlated with pepsin contents in 14 pa-tients at 1h after nasal feeding(r=- 0.4, P<0.05). Conclusion Patients receiving mechanical ventilation are more likely to aspirate in low cuff pressure, and the determination of pepsin content in bronchial secretions is useful for diagnosis of aspiration for critical patients receiving mechanical ventilation.