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
12期
870-874
,共5页
气管插管%气囊压力%机械通气%影响因素
氣管插管%氣囊壓力%機械通氣%影響因素
기관삽관%기낭압력%궤계통기%영향인소
Endotracheal tube%Endotracheal cuff pressure%Mechanical ventilation%Risk factor
目的：观察机械通气患者气管插管气囊压力情况及低气囊压力的影响因素。方法采用前瞻性队列研究方法，以首都医科大学附属复兴医院重症医学科预计机械通气时间≥48 h的气管插管成年患者为研究对象，测定入选时及每日07：00、15：00、23：00的气管插管气囊压力，以患者拔除气管插管或行气管切开或死亡为观察终点。根据患者观察期间低气囊压力发生率分为低气囊压力发生率＜25%组（低气囊压少组）和低气囊压力发生率＞25%组（低气囊压多组），比较两组间可能引起气囊压力变化的因素如体质指数、气管插管直径、气管插管使用时间、镇静和镇痛药物使用情况、重症监护病房（ICU）住院期间是否外出、翻身次数、吸痰次数等，采用logistic回归分析确定引起低气囊压发生较多的危险因素。结果最终53例患者入选，共测压812次，46.3%的气囊压力不在正常范围内，其中低气囊压力204次（占25.1%）。低气囊压力发生率＞25%的患者24例（占45.3%），平均低气囊压力发生7（4，10）次。与低气囊压少组比较，低气囊压多组首次气管插管使用时间明显延长〔h：162（113，225）比118（97，168），Z＝-2.034，P＝0.042〕，而两组间气管插管直径、气管插管至首次气囊压力测定的时间、ICU住院期间外出例数、镇静和镇痛时间、翻身次数、吸痰次数等可能影响气管插管气囊压力的因素均无明显差异（均P＞0.05）。Logistic回归分析并未发现影响低气囊压力的危险因素。两组患者呼吸机相关性肺炎发生率、机械通气时间、28 d脱机成功率、ICU病死率、28 d病死率比较差异均无统计学意义，而低气囊压多组ICU住院时间明显长于低气囊压少组〔d：13（8，21）比10（6，18），Z＝-2.120，P＝0.034〕。结论非正常范围内的气囊压力在气管插管患者中较为常见，气管插管使用时间越长，低气囊压力发生越频繁；需要加强对气囊压力的监测和管理。
目的：觀察機械通氣患者氣管插管氣囊壓力情況及低氣囊壓力的影響因素。方法採用前瞻性隊列研究方法，以首都醫科大學附屬複興醫院重癥醫學科預計機械通氣時間≥48 h的氣管插管成年患者為研究對象，測定入選時及每日07：00、15：00、23：00的氣管插管氣囊壓力，以患者拔除氣管插管或行氣管切開或死亡為觀察終點。根據患者觀察期間低氣囊壓力髮生率分為低氣囊壓力髮生率＜25%組（低氣囊壓少組）和低氣囊壓力髮生率＞25%組（低氣囊壓多組），比較兩組間可能引起氣囊壓力變化的因素如體質指數、氣管插管直徑、氣管插管使用時間、鎮靜和鎮痛藥物使用情況、重癥鑑護病房（ICU）住院期間是否外齣、翻身次數、吸痰次數等，採用logistic迴歸分析確定引起低氣囊壓髮生較多的危險因素。結果最終53例患者入選，共測壓812次，46.3%的氣囊壓力不在正常範圍內，其中低氣囊壓力204次（佔25.1%）。低氣囊壓力髮生率＞25%的患者24例（佔45.3%），平均低氣囊壓力髮生7（4，10）次。與低氣囊壓少組比較，低氣囊壓多組首次氣管插管使用時間明顯延長〔h：162（113，225）比118（97，168），Z＝-2.034，P＝0.042〕，而兩組間氣管插管直徑、氣管插管至首次氣囊壓力測定的時間、ICU住院期間外齣例數、鎮靜和鎮痛時間、翻身次數、吸痰次數等可能影響氣管插管氣囊壓力的因素均無明顯差異（均P＞0.05）。Logistic迴歸分析併未髮現影響低氣囊壓力的危險因素。兩組患者呼吸機相關性肺炎髮生率、機械通氣時間、28 d脫機成功率、ICU病死率、28 d病死率比較差異均無統計學意義，而低氣囊壓多組ICU住院時間明顯長于低氣囊壓少組〔d：13（8，21）比10（6，18），Z＝-2.120，P＝0.034〕。結論非正常範圍內的氣囊壓力在氣管插管患者中較為常見，氣管插管使用時間越長，低氣囊壓力髮生越頻繁；需要加彊對氣囊壓力的鑑測和管理。
목적：관찰궤계통기환자기관삽관기낭압력정황급저기낭압력적영향인소。방법채용전첨성대렬연구방법，이수도의과대학부속복흥의원중증의학과예계궤계통기시간≥48 h적기관삽관성년환자위연구대상，측정입선시급매일07：00、15：00、23：00적기관삽관기낭압력，이환자발제기관삽관혹행기관절개혹사망위관찰종점。근거환자관찰기간저기낭압력발생솔분위저기낭압력발생솔＜25%조（저기낭압소조）화저기낭압력발생솔＞25%조（저기낭압다조），비교량조간가능인기기낭압력변화적인소여체질지수、기관삽관직경、기관삽관사용시간、진정화진통약물사용정황、중증감호병방（ICU）주원기간시부외출、번신차수、흡담차수등，채용logistic회귀분석학정인기저기낭압발생교다적위험인소。결과최종53례환자입선，공측압812차，46.3%적기낭압력불재정상범위내，기중저기낭압력204차（점25.1%）。저기낭압력발생솔＞25%적환자24례（점45.3%），평균저기낭압력발생7（4，10）차。여저기낭압소조비교，저기낭압다조수차기관삽관사용시간명현연장〔h：162（113，225）비118（97，168），Z＝-2.034，P＝0.042〕，이량조간기관삽관직경、기관삽관지수차기낭압력측정적시간、ICU주원기간외출례수、진정화진통시간、번신차수、흡담차수등가능영향기관삽관기낭압력적인소균무명현차이（균P＞0.05）。Logistic회귀분석병미발현영향저기낭압력적위험인소。량조환자호흡궤상관성폐염발생솔、궤계통기시간、28 d탈궤성공솔、ICU병사솔、28 d병사솔비교차이균무통계학의의，이저기낭압다조ICU주원시간명현장우저기낭압소조〔d：13（8，21）비10（6，18），Z＝-2.120，P＝0.034〕。결론비정상범위내적기낭압력재기관삽관환자중교위상견，기관삽관사용시간월장，저기낭압력발생월빈번；수요가강대기낭압력적감측화관리。
Objective To investigate the prevalent condition of endotracheal cuff pressure and risk factors for under inflation. Methods A prospective cohort study was conducted. Patients admitted to the Department of Critical Care Medicine of Fuxing Hospital Affiliated to Capital Medical University,who were intubated with a high-volume low-pressure endotracheal tube,and had undergone mechanical ventilation for at least 48 hours,were enrolled. The endotracheal cuff pressure was determined every 8 hours by a manual manometer connected to the distal edge of the valve cuff at 07:00,15:00,and 23:00. Measurement of the endotracheal cuff pressure was continued until the extubation of endotracheal or tracheostomy tube,or death of the patient. According to the incidence of under inflation of endotracheal cuff,patients were divided into the incidence of under inflation lower than 25%group(lower low cuff pressure group)and higher than 25% group(higher low cuff pressure group). The possible influencing factors were evaluated in the two groups,including body mass index(BMI),size of endotracheal tube,duration of intubation,use of sedative or analgesic,number of leaving from intensive care unit(ICU),the number of turning over the patients, and aspiration of sputum. Logistic regression analysis was used to determine risk factors for under-inflation of the endotracheal cuff. Results During the study period,53 patients were enrolled. There were 812 measurements,and 46.3%of them was abnormal,and 204 times(25.1%)of under inflation of endotracheal cuff were found. There were 24 patients(45.3%)in whom the incidence of under inflation rate was higher than 25%. The average of under inflation was 7(4,10)times. Compared with the group with lower rate of low cuff pressure,a longer time for intubation was found in group with higher rate of low cuff pressure〔hours:162(113,225)vs. 118(97,168),Z=-2.034,P=0.042〕. There were no differences between the two groups in other factors,including size of endotracheal tube,the time from intubation to first measurement of endotracheal cuff pressure,number of leaving from ICU during admission, use of sedative agent or analgesic,and the number of body turning and aspiration(all P>0.05). No risk factor was found resulting from under inflation of the endotracheal cuff by logistic regression analysis. No significant difference was found in the incidence of ventilator associated pneumonia,duration of mechanical ventilation,successful rate of weaning on 28th day,or 28-day mortality after weaning from mechanical ventilation,and ICU mortality between the two groups. However,patients in the group of higher rate of low cuff pressure had a longer ICU stay compared with that in the group of lower rate of low cuff pressure group〔days:13(8,21)vs. 10(6,18),Z=-2.120,P=0.034〕. Conclusions Abnormal endotracheal cuff pressure is common in critically ill patients with intratracheal intubation. Duration of intubation is associated with under inflation of the cuff,and it calls for strengthening monitoring and management.
