套囊压力监测在机械通气中的临床研究与应用

目的探讨导管套囊压力监测在机械通气中的应用价值,提供不具备压力监测仪条件的套囊注气依据。方法对35例气管插管、气管切开机械通气的患者,先后在同一时间采用手指捏感法与套囊压力监测仪测压法进行囊内压值的对比研究。结果手指捏感测压法均值高于套囊压力表测压法(P<0.01)。结论对人工气道患者采用专用套囊测压仪指导套囊注气量及控制囊内压,能最大限度避免气道粘膜的损伤。     

机械通气病人气管导管套囊压力监测值的差异性研究

[目的] 探讨3种气管导管套囊压力监测方法的差异性。[方法] 对32例入住ICU的机械通气病人分别采用常规手指捏感法、最小闭合容量法、专用套囊测压表法各测气管导管囊内压1次，进行注气量及囊内压关系的比较。[结果] 手指捏感法测压值较压力表法及最小闭合容量法明显偏高（P均〈0．05），专用套囊测压表与最小闭合容量测压值比较，差异无统计学意义（P〉0．05）。[结论] 手指捏感法所测压力值偏高，专用套囊测压表法与最小闭合容量法可以相互取代，测压表法操作简便，测压准确可靠。     

机械通气病人气管导管套囊压力监测值的差异性研究

[目的]探讨3种气管导管套囊压力监测方法的差异性[方法]对32例入住ICU的机械通气病人分别采用常规手指捏感法、最小闭合容量法、专用套囊测压表法各测气管导管囊内压1次,进行注气量及囊内压关系的比较。[结果]手指捏感法测压值较压力表法及最小闭合容量法明显偏高(P均<0.05),专用套囊测压表与最小闭合容量测压值比较,差异无统计学意义(P>0.05)。[结论]手指捏感法所测压力值偏高,专用套囊测压表法与最小闭合容量法可以相互取代,测压表法操作简便,测压准确可靠。     

对机械通气患者气管套管气囊压力的临床观察

目的判断机械通气患者气管套管气囊压力和注气量是否合适。方法对30例机械通气老年患者的气管套管气囊压力和注气量的实际值和理想值进行精确测量。结果53.3％的患者气囊实际压力和注气量过高，大于理想值。其中气囊实际注气量大于理想注气量3～5ml，气囊压力超过理想压力2～26cmH2O(0．2～2．6kPa)。结论临床大部分气管套管气囊压力和注气量偏高，应对机械通气患者的气管套管压力和注气量定期进行精确测量和调整，以减少气管套管对气管粘膜的损伤。     

气管插管或气切套管套囊压力控制方法的对比研究

开放气道是临床常用的救治患者和实施麻醉的方法,而现行广泛开展的是气管插管或气管切开.气管插管或气管切开留置的导管一般带有套囊,气管插管或气切套管套囊的作用在于给套囊内注入一定量的气体.     

不同囊内压测定法对机械通气患者气囊压力的影响

目的:比较危重症患者机械通气时气囊实际压力,探讨合理而实用的注气标准。方法:用随机数字表法将120例因呼吸衰竭而建立人工气道行机械通气的患者随机分为手指捏感法组、固定注气法组和囊内压测定法组,每组各40例。用气管套管球囊压力专用测量仪(Endotest仪)对进行机械通气的危重症患者的气管套管、球囊压力进行精确测量。结果:手指捏感法组、固定注气法组和囊内压测定法组囊内压均随着充气时间的延长而降低,差异有统计学意义(均P<0.05)。与同一时间段手指捏感法组、固定注气法组相比,囊内压测定法组囊内压最低(均P<0.05),手指捏感法组、固定注气法组同一时间段囊内压差异无统计学意义(均P>0.05)。三组患者吸痰前后囊内压差异无统计学意义(均P>0.05)。与手指捏感法组、固定注气法组相比,囊内压测定法组不良事件最少,差异有统计学意义(P<0.05)。结论:测定囊内压能更好地起到保护患者的作用,减少并发症。     

一次性换能器在机械通气病人套囊压力测量中的应用

目的：通过与机械通气病人套囊压力专用测压表所测压力的比较,探讨一次性换能器在套囊压力测定方面的应用价值。方法：将96例重症监护室（ICU）机械通气病人随机分成两组,分别用专用测压表及换能器测量患者套囊压力及套囊容积进行比较。结果：两组呼吸机检查均不漏气,一次性换能器组套囊充气容积（7.51±1.15）mL,测得压力值（21.09±1.97）mmHg（1 mmHg=0.133 kPa）;压力表组套囊充气容积（7.25±1.15）mL,测得压力值（21.32±2.58）mmHg,套囊充气容积及测得压力值两组间比较差异（P〉0.05）均无统计学意义。结论：一次性换能器测压法是一种简单易行,准确可靠、成本低廉的科学、理想的方法,可以应用于临床测量机械通气病人套囊压力。     

机械通气患者的气道压力监测

~~机械通气患者的气道压力监测@吴益芬$浙江省丽水市人民医院监护室!浙江丽水323000 @郑艳萍$浙江省永康市第一人民医院护理部!浙江永康321300机械通气;;气道压力~~     

不同体位吸痰对人工气道套囊压力的影响

[目的]探讨不同体位吸痰对人工气道套囊压力的影响.[方法]2010年1月-10月在综合ICU病房行气管插管和气管切开病人62例,采用自身对照设计,应用套囊压力表于吸痰前给予套囊压力校正(25cmH2O),病人在平卧位、半卧位(床头抬高45°)吸痰时及吸痰后20min测定压力值并进行比较.[结果]半卧位吸痰时套囊压力(44.26cmH2O士12.06cmH2O)显著低于平卧位时套囊压力(54.27cmH2O±14.65cmH2O).[结论]人工气道病人吸痰时尽量保持半卧位,以减轻套囊压力对气管黏膜的损伤.     

锥形套囊气管导管临床应用研究进展

目的 分析锥形套囊气管导管的临床应用研究现状,为形成科学、标准的锥形套囊气管导管使用管理规范提供依据。方法 查阅国内外相关文献,从锥形套囊气管导管的临床应用情况、临床应用效果、气囊压力管理等方面进行综述。结果 锥形套囊气管导管近年来逐渐应用于临床,其渐进式的锥形套囊设计具有良好的封闭效果,能够减少微量误吸,有效预防早期呼吸机相关性肺炎的发生。锥形套囊压力管理和护理方法等方面的研究较少,其套囊压力更易产生变化,需加强监测和管理。结论 在现有研究的基础上进一步探讨锥形套囊压力变化的影响因素和监测方法,以形成相应规范,更好地发挥其预防呼吸机相关性肺炎等并发症的作用。可进行锥形套囊可吸引冲洗气管导管的吸引、冲洗方法和效果的临床对照研究。     

Evaluation of respiratory system resistance in mechanically ventilated patients: The role of the endotracheal tube

Objective To investigate the role played by the endotracheal tube (ETT) in the correct evaluation of respiratory system mechanics with the end inflation occlusion method during constant flow controlled mechanical ventilation.Setting General ICU, university of Rome La Sapienza.Patients 12 consecutive patients undergoing controlled mechanical ventilation.Methods We compared the values of minimal resistance of the respiratory system (i.e. airway resistance) (RRS min) obtained: i) subtracting the theoretical value of ETT resistance from the difference between P max and P1, measured on airway pressure tracings obtained from the distal end of the ETT; ii) directly measuring airway pressure 2 cm below the ETT, thus automatically excluding ETT resistance from the data.Results The values of RRS min obtained by measuring airway pressure below the ETT were significantly lower than those obtained by measuring airway pressure at the distal end of the ETT and subtracting the theoretical ETT resistance (4.5±2.8 versus 2.5±1.6 cm H₂O/l/s,p<0.01).Conclusion When precise measurements of ohmic resistances are required in mechanically ventilated patients, the measurements must be obtained from airways pressure data obtained at tracheal level. The in vivo positioning of ETT significantly increases the airflow resistance of the ETT.     

机械通气气管套囊控制指标对家兔气管黏膜的影响

目的探讨机械通气气管套囊指标对急性肺损伤兔气管黏膜组织超微结构的影响。方法健康兔90只,按气囊压力不同分为A（气囊压力30cmH2O,气囊充气时间1h、2h、4h、8h）、B（气囊压力20cmH2O,气囊充气时间1h、2h、4h、8h）、C（气囊压力20cmH2O,每隔2h、4h、8h气囊放气10、20、30min）、D（对照组）4组,分别对气管黏膜进行电镜超微结构观察。结果气囊压力20cmH2O维持〈8h,上皮少量纤毛缺失,柱状上皮细胞轻度肿胀,每隔4h放气20min,上皮细胞层次较清晰,细胞形态基本正常。结论气囊压力在20cmH2O对气管黏膜的损伤最轻;气囊充气4h后放气时间≥20min再充气,可减轻气管黏膜损伤。     

鼻空肠管在机械通气患者早期肠内营养中的应用

目的探讨对机械通气(MV)患者留置鼻空肠管行早期肠内营养的应用价值。方法将ICU收治的50例机械通气患者随机分为A组(25例)和B组(25例),A组留置鼻空肠管,B组留置鼻胃管,观察两组肠内营养可以耐受的起始时间、达目标喂养量所需时间、并发症情况和机械通气时间。结果A组肠内营养可以耐受起始时间、达目标喂养量所需时间明显比B组短(P＜0．01),并发症发生率和呼吸机相关肺炎(VAP)发生率明显减少(P＜0．05),机械通气时间较B组明显缩短(P＜0．05)。结论机械通气患者留置鼻空肠管实施早期肠内营养比鼻胃管更为有效、安全,并有助于减少VAP发生,有助于尽早脱机。     

注药式气管导管在术后ICU病人机械通气中的应用

目的 采用注药式气管导管对术后机械通气的ICU病人行气道表面麻醉，观察机械通气过程中病人对气管导管的耐受情况。方法 选择34例胸腹部手术、术后行机械通气12h以上的病人，随机分为两组，每组17例。对照组（C组）：经注药式气管导管气管内注射生理盐水；治疗组（T组）：经注药式气管导管气管内注射2％利多卡因。观察病人在机械通气12h内气管导管的耐受情况和镇静药物咪唑安定、芬太尼的给药次数及使用量的变化。结果 治疗组病人在机械通气12h内呛咳反应、高血压和心动过速的发生次数显著低于对照组（P〈0．05）；治疗组病人在机械通气12h内咪唑安定和芬太尼给药次数和使用量显著低于对照组（P〈0．05）。结论 使用注药式气管导管进行气道表面麻醉可以显著减轻气管导管引起的不适反应，减少ICU病人的镇静药物用量。     

The accurate measurement of endotracheal tube cuff pressures

The effects of endotracheal tube cuff pressure upon the tracheal wall is well documented and researched. Hyperinflation causes mucosal damage subsequent to restricted capillary blood flow (Seegobin and Hasselt, 1984), and underinflation increases aspiration risk (Bernard et al, 1979). There are critical care areas with no method of obtaining accurately cuff pressure other than adopting the minimal occlusion technique, i.e. inserting just enough air into the cuff to prevent air leakage. Although this is a useful method for obtaining an adequate seal, it does not safeguard against hyperinflation. The aim of this study was to demonstrate that without accurate measurement of intracuff pressures of endotracheal tubes, pressure will be outside the normal recommended limits, which could place patients at risk. Accurate measurements of cuff pressures post cardiac surgery were recorded using a Malincrodt pressure gauge. Theatre staff and intensive care unit nursing staff were unaware of the study until its completion. It is concluded that cuff pressures are too high using the minimal occlusion technique and the cuffs are prone to leaking.     

Effect of PEEP on work of breathing in mechanically ventilated COPD patients

Objective: To study the effects of PEEP on the inspiratory work done per breath on the respiratory system (W_I,rs) in patients with chronic obstructive pulmonary disease (COPD).¶Design: Physiological study.¶Setting: Fourteen-bed Medical ICU of a 1000-bed teaching tertiary hospital.¶Patients and participants: Ten patients with COPD intubated and mechanically ventilated for acute respiratory failure.¶Interventions: PEEP of 0 (ZEEP), ¶5, 10, and 15 cm H₂O were applied randomly and measurements done at the end of a 15–20 min period.¶Measurements and results: Using the rapid airway occlusion technique during constant flow inflation, we partitioned W_I,rs into its static and dynamic components. On ZEEP, the mean ± SD values of W_I,rs amounted to 15.1 ± 5.7 cm H₂O × l. With increasing PEEP, W_I,rs was significantly reduced to 12.6 ± 5.7, 11.1 ± 4.1, and 10.4 ± 2.8 cm H₂O × l at PEEP of 5, 10, and 15 cm H₂O, respectively (P < 0.05). This reduction was entirely due to the decline of the work due to intrinsic PEEP (PEEPi) and was abolished when the applied PEEP counterbalanced PEEPi. The other components of W_I,rs were not affected by PEEP. By increasing PEEP up to the level of PEEPi on ZEEP, no further increase in end-expiratory lung volume was observed.¶Conclusions: In COPD patients the application of PEEP levels close to PEEPi can substantially reduce W_I,rs without promoting further dynamic pulmonary hyperinflation.     

机械通气患者人工气道囊内压对呼气末正压的影响分析

正压通气加呼气末正压(PEEP)通气策略是抢救危重患者特别是呼吸功能障碍患者的常用治疗方法,已被广泛应用于临床.气管导管气囊充气不仅保证了正压通气的有效实施,而且阻挡了口鼻咽部分泌物下行产生误吸导致的呼吸机相关性肺炎(VAP)发生[1].