应用最小漏气法确定人工气道气囊压的临床研究

来源 :中华危重病急救医学 | 被引量 : 0次 | 上传用户:xqm009
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
目的:对比最小漏气法与囊压表法给气管插管气囊注气后的气囊压力和呼吸机漏气量以及患者相关并发症,为临床气管插管患者获得合适的气囊压提供理论依据。方法:采用前瞻性随机对照研究,选择2015年12月至2019年6月天津市第五中心医院重症医学科收治的100例需气管插管机械通气的成人患者。按照随机数字表法将患者分为试验组和对照组,每组50例。气管插管成功后,所有患者均取平卧位,床头抬高30°。试验组应用最小漏气法给气囊注气,并应用气囊测压表获得气囊压力值;对照组应用囊压表法注气使气囊压力达到25~30 cmHn 2O(1 cmHn 2O=0.098 kPa)。比较两组患者初次充气时(0 h)和充气4 h、8 h气囊压力及呼吸机漏气量等参数,以及患者拔除气管导管后呼吸机相关性肺炎(VAP)及气道并发症的发生情况。n 结果:100例重症患者中男性53例,女性47例;年龄23~87岁,平均(68.53±8.46)岁;气管导管留置时间1~16 d。①两组患者4 h和8 h时气囊压力均较初次充气时降低,呼吸机漏气量均随时间延长逐渐增加。与对照组比较,试验组各时间点气囊压力均明显高于对照组〔mmHg(1 mmHg=0.133 kPa):0 h为33.72±9.14比25.68±5.26,4 h为30.54±7.81比24.35±4.93,8 h为26.57±5.64比22.42±4.14,均n P<0.05〕,呼吸机漏气量均小于对照组(mL:0 h为25.57±8.51比34.65±9.47,4 h为40.54±8.51比60.34±7.85,均n P<0.05)。②试验组VAP发生率明显低于对照组(4%比10%,n P0.05)。n 结论:最佳的气囊压力对预防VAP及减少气道并发症十分重要,最小漏气法使临床获得的气管插管气囊压更加精准,漏气量少,且安全有效,值得临床推广。“,”Objective:To compare the cuff pressure and leakage volume and the related complications of filling the tracheal tube cuff by minimum air leakage method and cuff pressure manometer method after endotracheal intubation, so as to provide theoretical basis for patients who was intubated to obtain appropriate cuff pressure.Methods:A prospective randomized controlled study was conducted. 100 patients admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from December 2015 to June 2019 were enrolled. According to the random number table method, the patients were divided into the experimental group and control group, with 50 patients in each group. After successful endotracheal intubation, all patients were placed in a supine position with the head of the bed raised by 30°. The experimental group used the minimum air leakage method, and used the cuff pressure manometer to obtain the cuff pressure. In the control group, cuff pressure was maintained at 25-30 cmHn 2O (1 cmHn 2O = 0.098 kPa). Parameters such as cuff pressure and ventilator leakage volume at the beginning and 4 hours, 8 hours after the inflation were compared between the two groups, as well as the incidence of ventilation-associated pneumonia (VAP) and airway complications after extubation.n Results:Among the 100 cases, 53 were males and 47 were females. The age ranged from 23 to 87 years old, with an average of (68.53±8.46) years old. The intubation time ranged from 1 to 16 days.① At 4 hours and 8 hours after inflation, the cuff pressures of the two groups were lower than that of the first time of inflation, and the air leakage of the ventilator increased gradually with the extension of time. Compared with the control group, cuff pressures at each time point in the experimental group were significantly higher than those in the control group [mmHg (1 mmHg = 0.133 kPa): 33.72±9.14 vs. 25.68±5.26 at 0 hour, 30.54±7.81 vs. 24.35±4.93 at 4 hours, 26.57±5.64 vs. 22.42±4.14 at 8 hours, all n P < 0.05], and ventilator leakage volumes were smaller than those in the control group (mL: 25.57±8.51 vs. 34.65±9.47 at 0 hour, 40.54±8.51 vs. 60.34±7.85 at 4 hours, both n P < 0.05). ② The incidence of VAP in the experimental group was significantly lower than that in the control group (4% vs. 10%, n P 0.05).n Conclusions:The optimal cuff pressure is very important for preventing VAP and reducing airway complications. The minimum air leakage method makes the clinical obtained endotracheal intubation cuff pressure more accurately, with less air leakage, safe and effective, and it is worthy of clinical promotion.
其他文献
某些毒物在低剂量时对生物体的刺激导致反馈改善的现象,简称“毒物兴奋效应”.是一个近年发展兴起的生物细胞及生物体抗应激、抗衰老研究的新领域,其分子机制正在被逐步阐明.
为研究乳腺肿瘤核磁(Magnetic Resonance,MR)图像纹理分析在鉴别乳腺纤维瘤(fibroadenoma of breast,FB)、浸润性导管癌(invasive ductal carcinoma, IDC)和浸润性小叶癌(invasive lobular carcinoma, ILC)中的临床应用价值,选择MR图像的兴趣区域并使用小波变换对MR图像进行分解,结合K-means算法
对街头官僚理论的研究是近些年公共行政理论界兴起的一个重要的研究领域,主要关注街头官僚所拥有的自由裁量权和他们的决策能力。“街头官僚”主要是指处于基层同时也是最前线
上世纪90年代以来,随着我国经济和社会改革的深化,尤其是经济建设进程的不断加快,社会各项事业发展不均衡日益加剧,各阶层的利益诉求趋向多样化,各种矛盾纠纷随之层出不穷,出现了部
劳动保障监察网格化管理是当代中国政府致力推行的一种执法模式。为了落实科学发展观和构建社会主义和谐社会,进一步解决劳动保障监察工作中存在的问题,提高劳动保障监察管理
我于1988年第一次郑重地向学校党组织递交了入党申请书。1989年春夏之交北京发生了动乱,也没有动摇我的信念,仍然执著地追求共产党。东欧剧变、苏联解体后,有的朋友功我说:
金欣简介:作为中国流通供应链信息化(eService)领导型创新实践者和中国供应链运营智能化/标准化的创新型理论研究者。主导开发中国第一的电子商务综合服务解决方案—富基“商
期刊
读了周总理一九六一年关于文艺问题的讲话,我有很多感触。这个重要讲话,当年我未能亲耳听到,但是有些热心的同志向我传达了讲话的精神。当时上海市委的那个主要负责人,总是
基于已有的视觉空间和文本空间上标签相关性建模方法,提出一种多模态子空间学习的语义标签生成方法。通过建立视觉特征相似图,以非线性方式重构"图像-标签"相关性,进而将图像的视觉模态表示和标签的文本模态表示统一到多模态子空间中,并保证空间变换前后具备结构保持。在该空间中,标签的文本模态与图像的视觉内容模态信息彼此互补,语义相关的图像和标签映射到空间中相近的样本点,进而将语义标签生成问题转换为子空间内图像
职务犯罪等腐败现象与社会经济现代化有着密切的关系。近年来,我国交通基础设施建设步伐加快,特别是高速公路建设投资不断加大,如何有效预防和控制高速公路工程建设领域的腐