CAJ | 학술논문

目的：通过模拟实验及临床研究，观察柱形套囊气管导管与锥形套囊气管导管的密封性能，比较两种形状套囊对呼吸机相关性肺炎（VAP）的预防作用。方法（1）实验研究：将相同型号的柱形套囊气管导管与锥形套囊气管导管同时进行静态液体密封测试，观察10 min内套囊上液体渗漏情况；（2）临床研究：根据患者转入ICU选择不同形状套囊导管进行分组，柱形套囊组132例，锥型套囊组105例，两组病例均从气管导管冲洗管内注入0．2％亚甲蓝5 ml ，用纤维支气管镜观察气管黏膜染色情况，统计VAP发生率和发生时间。结果（1）10 min内，相同型号的锥形套囊气管导管液体渗漏量明显少于柱形套囊气管导管；（2）锥形套囊组预防VAP的发生率优于柱形套囊组，特别是预防早期VAP发生率优于柱形套囊组；但在预防长期留置导管VAP方面，两组没有明显差异；锥形套囊组发生VAP的时间明显较柱形套囊组晚。结论使用封闭效果良好的锥型套囊导管，可减少声门下滞留物的渗漏量，延迟VAP发生的时间。
목적：통과모의실험급림상연구，관찰주형투낭기관도관여추형투낭기관도관적밀봉성능，비교량충형상투낭대호흡궤상관성폐염（VAP）적예방작용。방법（1）실험연구：장상동형호적주형투낭기관도관여추형투낭기관도관동시진행정태액체밀봉측시，관찰10 min내투낭상액체삼루정황；（2）림상연구：근거환자전입ICU선택불동형상투낭도관진행분조，주형투낭조132례，추형투낭조105례，량조병례균종기관도관충세관내주입0．2％아갑람5 ml ，용섬유지기관경관찰기관점막염색정황，통계VAP발생솔화발생시간。결과（1）10 min내，상동형호적추형투낭기관도관액체삼루량명현소우주형투낭기관도관；（2）추형투낭조예방VAP적발생솔우우주형투낭조，특별시예방조기VAP발생솔우우주형투낭조；단재예방장기류치도관VAP방면，량조몰유명현차이；추형투낭조발생VAP적시간명현교주형투낭조만。결론사용봉폐효과량호적추형투낭도관，가감소성문하체류물적삼루량，연지VAP발생적시간。
Objective To observe the sealing performance of cylindrical cuff endotracheal tube and tapered endo‐tracheal tube cuff trough simulation experiment and clinical study ,and to compared the preventive effect on ventila‐tor‐associated pneumonia (VAP) by the two shapes cuff .Method (1) Experimental study :the same type of cylin‐drical cuff endotracheal tube and tapered endotracheal tube cuff was used to conduct static liquid seal test .The liquid leakage on the cuff within 10 min was observed .(2) Clinical study :Grouped by different type sleeve sac cannula for hospitalized patients in ICU .132 cases in cylindrical sleeve bag group ,105 cases in taper sleeve capsule group , 0 .2% methylene 5ml was infused into the two group from the tracheal catheter flushing pipe .The tracheal mucosa staining was observed by fiberoptic bronchoscopy .The incidence and occurrence time of VAP was measured statisti‐cally for the two groups .Result (1) The same type of cone cuffed endotracheal tube was significantly less than the cylindrical liquid leakage cuffed endotracheal tube within 10 min .(2) The incidence of VAP prevention in tapered cuff group is better than that of cylindrical cuff group ,particularly for prevention of early VAP occurrence .There were no significant difference for prevention of long‐term indwelling catheters VAP .The time of VAP occurred in tapered cuff group was later than that of cylindrical cuff group .Conclusion Good seal tapered cuff catheters can re‐duce leakage of subglottic retentate ,and delay the time of VAP occurrence .