中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
5期
347-350
,共4页
林艳侠%林丹%陈碧群%纪超%袁从丽%王宝春
林豔俠%林丹%陳碧群%紀超%袁從麗%王寶春
림염협%림단%진벽군%기초%원종려%왕보춘
气囊压力管理%间断监测%偏差%实验研究
氣囊壓力管理%間斷鑑測%偏差%實驗研究
기낭압력관리%간단감측%편차%실험연구
Management of the cuff pressure%Monitoring intermittently%Bias%Experimental study
目的 探讨气囊压力表间断测量人工气道气囊压力时,测量值与实际值之间是否存在偏差、偏差来源和偏差大小,为气囊压力表的正确使用提供参考.方法 在实验室体外实验中,采用专用手持气囊压力表通过三通开关与人工气道气囊充气管线单向阀连接,通过三通的开关控制,测量气囊压力,得到测量值偏差后进行临床试验加以验证.研究对象为建立人工气道需行气囊压力监测的成人患者.结果 在实验室经过132次测量发现,手持压力表本身会造成气囊压力下降,称之为固有损失;充气值[(30.000±0.000) cmH2O,1 cmH2O=0.098 kPa]和测量值[(26.072±0.291)cmH2O]之间存在明显偏差,平均为(3.928±0.291)cmH2O(t=155.273,P=0.000);经过214次测量发现,充气管线单向阀在与压力表断开和连接的过程中造成气囊压力下降,称之为误差损失;充气值[(30.000±0.000) cmH2O]和测量值[(28.804±0.954) cmH2O]之间存在偏差,平均为(1.196±0.954) cmH2O(t=18.348,P=0.000).临床经过21 1次验证试验得到固有损失和误差损失两者之和,充气值[(30.000±0.000) cmH2O]和测量值[(24.730±2.583) cmH2O]之间同样存在偏差(即测量偏差),其值为(5.270±2.583) cmH2O(t=29.632,P=0.000).结论 使用气囊压力表进行间断测量气囊压力时,气囊原有的实际压力应为测量值与偏差值之和,且在连接前应先进行声门下吸引,以防止气囊上方分泌物因气囊体积缩小而滑向气道深部而引起误吸,并将气囊压力维持在30 cmH2O.
目的 探討氣囊壓力錶間斷測量人工氣道氣囊壓力時,測量值與實際值之間是否存在偏差、偏差來源和偏差大小,為氣囊壓力錶的正確使用提供參攷.方法 在實驗室體外實驗中,採用專用手持氣囊壓力錶通過三通開關與人工氣道氣囊充氣管線單嚮閥連接,通過三通的開關控製,測量氣囊壓力,得到測量值偏差後進行臨床試驗加以驗證.研究對象為建立人工氣道需行氣囊壓力鑑測的成人患者.結果 在實驗室經過132次測量髮現,手持壓力錶本身會造成氣囊壓力下降,稱之為固有損失;充氣值[(30.000±0.000) cmH2O,1 cmH2O=0.098 kPa]和測量值[(26.072±0.291)cmH2O]之間存在明顯偏差,平均為(3.928±0.291)cmH2O(t=155.273,P=0.000);經過214次測量髮現,充氣管線單嚮閥在與壓力錶斷開和連接的過程中造成氣囊壓力下降,稱之為誤差損失;充氣值[(30.000±0.000) cmH2O]和測量值[(28.804±0.954) cmH2O]之間存在偏差,平均為(1.196±0.954) cmH2O(t=18.348,P=0.000).臨床經過21 1次驗證試驗得到固有損失和誤差損失兩者之和,充氣值[(30.000±0.000) cmH2O]和測量值[(24.730±2.583) cmH2O]之間同樣存在偏差(即測量偏差),其值為(5.270±2.583) cmH2O(t=29.632,P=0.000).結論 使用氣囊壓力錶進行間斷測量氣囊壓力時,氣囊原有的實際壓力應為測量值與偏差值之和,且在連接前應先進行聲門下吸引,以防止氣囊上方分泌物因氣囊體積縮小而滑嚮氣道深部而引起誤吸,併將氣囊壓力維持在30 cmH2O.
목적 탐토기낭압력표간단측량인공기도기낭압력시,측량치여실제치지간시부존재편차、편차래원화편차대소,위기낭압력표적정학사용제공삼고.방법 재실험실체외실험중,채용전용수지기낭압력표통과삼통개관여인공기도기낭충기관선단향벌련접,통과삼통적개관공제,측량기낭압력,득도측량치편차후진행림상시험가이험증.연구대상위건립인공기도수행기낭압력감측적성인환자.결과 재실험실경과132차측량발현,수지압력표본신회조성기낭압력하강,칭지위고유손실;충기치[(30.000±0.000) cmH2O,1 cmH2O=0.098 kPa]화측량치[(26.072±0.291)cmH2O]지간존재명현편차,평균위(3.928±0.291)cmH2O(t=155.273,P=0.000);경과214차측량발현,충기관선단향벌재여압력표단개화련접적과정중조성기낭압력하강,칭지위오차손실;충기치[(30.000±0.000) cmH2O]화측량치[(28.804±0.954) cmH2O]지간존재편차,평균위(1.196±0.954) cmH2O(t=18.348,P=0.000).림상경과21 1차험증시험득도고유손실화오차손실량자지화,충기치[(30.000±0.000) cmH2O]화측량치[(24.730±2.583) cmH2O]지간동양존재편차(즉측량편차),기치위(5.270±2.583) cmH2O(t=29.632,P=0.000).결론 사용기낭압력표진행간단측량기낭압력시,기낭원유적실제압력응위측량치여편차치지화,차재련접전응선진행성문하흡인,이방지기낭상방분비물인기낭체적축소이활향기도심부이인기오흡,병장기낭압력유지재30 cmH2O.
Objective To explore the bias between the real pressure and the measured values when handheld pressure gauge (HPG) was used to monitor intermittently the pressure in the intubation balloon,so as to provide some measures for the correct use of HPG.Methods In the first part of the study,HPG was used to measure the pressure with the balloon connected with a three-way tube with which to control the inflation and deflation in a laboratory to measure the pressure in the air bag.After gaining the deviation in this in vitro experiment,it was tested and verified in vivo in adult patients undergoing endotracheal intubation.Results After 132 times of measurements,it was found that measurement with a HPG might result in an "inherent loss" (3.928 ± 0.291) cmH2O (1 cmH2O=0.098 kPa,t =155.273,P =0.000) between inflation value [(30.000 ± 0.000) cmH2O] and measured value [(26.072 ± 0.291) cmH2O].In addition,after 214 times repeated measurements,the pressure "loss" during disconnection of the gauge was as high as (1.196 ± 0.954) cmH2O (t=18.348,P=0.000) between filled values [(30.000 ± 0.000) cmH2O] and measured values [(28.804 ± 0.954) cmH2O] and it was named as "error loss".At last,the total error was verified by clinical test,and it was (5.270 ± 2.583) cmH2O (t=29.632,P=0.000) between pressure of filled value [(30.000 ± 0.000) cmH2O] and measured value [(24.730 ± 2.583) cmH2O].Conclusions When the balloon pressure was Monitored intermittently with HPG,the real value should be the measured value plus the "error".In addition,subglottic aspiration should be done before the connection of the balloon to the gauge to prevent the secretions on the cuff falls into the deeper airway,and to maintain the cuff pressure at 30 cmH2O.
