气管插管鉴定囊对气管内插管时呼出气体和飞沫的阻断效果

目的 观察一种新研制的气管插管鉴定囊在急诊气管内插管时对患者呼出气体或飞沫的阻断效果.方法 选择急诊抢救中需气管内插管的62例患者进行观察试验,性别不限,年龄21～73岁,所选患者均有不同程度的意识和自主呼吸;按随机数字表法分为两组,每组31例患者.对照组(C组)用普通气管导管;气管插管鉴定囊组(T组)在气管内插管时用接有气管插管鉴定囊的气管导管.观察并记录两组插管过程中有无呛咳发生、操作者面颈部有无感受到在气管导管口处有呼出气流、操作者面颈部有无受到血液或分泌物的沾染.结果 T组全部患者在插管时气管插管鉴定囊均出现了胀缩,但操作者没有感觉到在气管导管口处有呼出气流;插管期间有9例患者发生了呛咳,其中2例使操作者面颈部受到了沾染.C组中有16例插管使操作者感受到在气管导管口处有呼出气流,其中7例出现了呛咳,11例使操作者面颈部受到了沾染.与C组比较,T组的操作者感受到有呼出气流和受到血液、分泌物沾染的发生率低(0比16,2比11,均P＜0.05),插管过程中患者呛咳的发生率差异无统计学意义(9比7,P＞0.05).结论 气管插管鉴定囊用于气管内插管时能够起到阻断呼出气体泄漏或飞沫播散的作用,有助于防控插管时血液或分泌物的喷溅.     

SLIPA喉罩与气管插管对腹腔镜胆囊手术患者心血管应激反应的比较

目的探讨SLIPA喉罩与气管插管两种通气方式在全麻腹腔镜下胆囊手术患者心血管应激反应的差异。方法选择我院择期全麻下腹腔镜胆囊手术患者65例,按照入院随机数字表随机分为喉罩组和气管插管组,喉罩组为置入SLIPA喉罩,气管插管组为插入气管导管,比较两组置罩管（罩）前后以及拔管（罩）前后HR和MAP变化以及波动幅度。结果两组置罩（管）前HR、MAP差异无统计学意义（P〉0.05）;喉罩组置/拔罩前后HR、MAP差异无统计学意义（P〉0.05）;气管插管组置/拔管前后HR、MAP差异有统计学意义（P〈0.05）;喉罩组置/拔罩前后HR、MAP波幅变化显著低于气管插管组,差异有统计学意义（P〈0.05）。结论 SLIPA喉罩在麻醉过程中血流动力学平稳,机体应激反应轻,心率、血压波动幅度小,可望成为具有心血管基础疾病患者麻醉气道管理的一个新的选择。     

气管插管病人胃管置入方法研究

目的：探讨气管插管病人胃管置入方法。方法：将60例气管插管病人随机分为：头部前倾组（A组）和镇静状态下牵拉气管组（B组）各30例;观察并比较一次置管成功率,置管前后HR、SpO2及置管过程中呛咳发生率。结果：①一次置管成功率比较,B组显著高于A组（P〈0.01）。②置管后HP、SpO2与各自置管前相比,A组置管过程中呛咳发生率显著高于B组（P〈0.01）。结论：对气管插管病人在镇静状态下牵拉气管的同时置入胃管准确性高、不良反应少。     

舒芬太尼对气管插管诱发的血流动力学和BIS变化的影响

目的观察在常规麻醉诱导的基础上加用舒芬太尼对气管插管诱发的血流动力学和脑电双频指数（BIS）变化的影响。方法选择全麻下手术患者80例随机分为4组（n=20）：对照组（C组）、舒芬太尼0.1μg/kg组（S0.1组）、舒芬太尼0.2μg/kg组（S0.2组）和舒芬太尼0.3μg/kg组（S0.3组）。患者在常规麻醉诱导的基础上给予生理盐水、舒芬太尼0.1,0.2和0.3μg/kg,观察诱导后、气管插管后不同时间平均动脉压（MAP）、心率（HR）和BIS值的变化。结果相对于诱导前,C组气管插管后不同时间MAP、HR显著升高（P〈0.05）;S0.1组诱导后和气管插管后不同时间MAP、HR没有显著变化（P〉0.05）;S0.2组注射舒芬太尼后2 min MAP和HR显著减少（P〈0.05）;S0.3组注射舒芬太尼后2 min MAP和HR显著减少（P〈0.05）,气管插管不同时间MAP显著减低（P〈0.05）。S0.1组、S0.2组和S0.3组气管插管不同时间BIS值显著低于诱导前和C组（P〈0.05）。结论在常规麻醉诱导的基础上附加使用舒芬太尼可以消除气管插管对患者血流动力学和BIS值的影响。     

不同吸痰管在心外科ICU术后机械通气患者中应用的效果比较

目的比较应用密闭式吸痰管和开放式吸痰管对成人心外科术后感染预防和控制效果的影响。方法选择心外科术后行机械通气患者159例,随机分为密闭式吸痰组（n=77）和开放式吸痰组（n=82）,比较两组患者术后当天及术后第1,2,3天的白细胞计数,拔管前痰培养阳性率及总机械通气时间。结果密闭式吸痰组与开放式吸痰组的白细胞计数在术后当天[（10．42±3．81）×10^9／L比（9．44±3．36）×10^9／L]和第1天[（12．03±3．87）×10^9／L比（11．32±3．59）×10^9／L]差异无统计学意义（t分别为-1．718,-1．188;P〉0．05）;而密闭式吸痰组白细胞计数术后第2天[（16．14±5．78）×10^9／L比（14．81±3．68）×10^9／L]、第3天[（15．09±5．91）×10^9／L比（12．65±3．18）×10^9／L]高于开放式吸痰组,差异有统计学意义（t分别为-2．044,-2．409;P〈0．05）。密闭式吸痰组痰标本细菌培养阳性率高于开放式吸痰组（12．2％比10．4％）,但差异无统计学意义（χ2=0．129,P=0．72）,总机械通气时间长于开放式吸痰组[（14．48±4．71）h比（12．15±4．47）h],差异有统计学意义（t=2．994,P=0．003）。结论密闭式吸痰管的吸痰效果不及开放式吸痰管,由于吸痰不彻底导致的细菌定植发生率较高,从而导致肺部感染率增加。而且对于心外科术后短期带管的患者来说,密闭式吸痰装置的费用较高。     

SLIPA喉罩和气管插管应用于腹腔镜胆囊切除术气道管理安全性和有效性的Meta分析

目的 应用Meta分析方法评价SLIPA喉罩与气管插管(TT)在腹腔镜胆囊切除术中气道管理的安全性和有效性.方法 计算机检索PubMed (1992.2 ～ 2012.2)、EMbase (1984 ～ 2012.2),MEDLINE (Ovid,1946～2012.2)、SCI(1992.2～2012.2)、CNKI(1992 ～ 2012.2)、CBM(2002 ～ 2012.2)和WanFang Data( 1996～2012.2),查找SLIPA喉罩和气管插管应用于腹腔镜胆囊切除术的随机对照试验,并进一步追溯所获文献的参考文献,查阅各种会议纪录、研究生论文等.按照纳入和排除标准,由2位研究人员独立选择文献、提取资料,并按照Cochrane手册5.0版的偏倚风险评估工具对纳入研究的方法学质量进行评价,然后采用RevMan 5.0软件进行Meta分析.结果 共纳入10个随机对照试验,664例患者.Meta分析结果显示:①所有研究对象在术中均未发生反流误吸、通气不足等意外;②SLIPA组的拔管反应明显少于TT组[RR=0.14,95％CI (0.05,0.36),P＜0.000 1];③SLIPA组术后咽痛发生例数明显少于TT组[RR=0.15,95％CI (0.06,0.38),P＜0.000 1];④气腹形成后,二组气道峰压差异无统计学意义;⑤气腹形成后,SLIPA组呼气末CO2分压低于TT组[WMD=- 1.09,95％CI(-1.70,-0.49),P=0.000 4];⑥在血流动力学指标变化方面,TT组较SLIPA组波动明显,其差异均有统计学意义(P均＜0.05).结论 在腹腔镜胆囊切除术中,SLIPA喉罩是一种安全、有效的气道管理方式.受纳入研究的方法学质量和数量限制,上述结论尚需更多高质量研究加以验证.     

Increasing suction pressure during endotracheal suctioning increases the volume of suctioned secretions,but not procedure-related complications: A comparative study in open system endotracheal suctioning

ObjectivesTo compare the effect of three different suction pressures (80 mmHg, 150 mmHg, 250 mmHg) with the open system suction method in terms of the volume of secretions and complications development in intubated intensive care patients.Research methodology/designThis study was planned as a prospective, experimental, self-controlled design. The study sample included 47 patients. Data were collected using a data collection and patient follow-up form from patient records.SettingSingle adult intensive care unit in a university hospital.ResultsFifty five percent of the patients were male, 61.7% were older than 65 years and 38.32% had lung infection. The amount of suctioned secretions tended to increase significantly with increasing negative pressure and there was a significant difference between the pressures in terms of the median volume of suctioned secretions (p < 0.001). There was no significant difference between the suction pressures in terms of oxygen desaturation, hypertension rates (p > 0.05). Tachycardia, bradycardia, hypoxaemia, tracheal mucosal damage or mucosal bleeding were not observed during suctioning with three different suction pressures.ConclusionIt may be assumed that 250 mmHg suction pressure, via compliance with open system suction method related procedures, is being more effective and equally safe for secretion cleaning in comparison to the 80 and 150 mmHg suction pressures.     

Appropriate use criteria for endotracheal suction interventions in mechanically ventilated children: The RAND/UCLA development process

ObjectivesEndotracheal suction is an invasive airway clearance technique used in mechanically ventilated children. This article outlines the methods used to develop appropriate use criteria for endotracheal suction interventions in mechanically ventilated paediatric patients.MethodsThe RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop paediatric appropriate use criteria. This included the following sequential phases of defining scope and key terms, a literature review and synthesis, expert multidisciplinary panel selection, case scenario development, and appropriateness ratings by an interdisciplinary expert panel over two rounds. The panel comprised experts in the fields of paediatric and neonatal intensive care, respiratory medicine, infectious diseases, critical care nursing, implementation science, retrieval medicine, and education. Case scenarios were developed iteratively by interdisciplinary experts and derived from common applications or anticipated intervention uses, as well as from current clinical practice guidelines and results of studies examining interventions efficacy and safety. Scenarios were rated on a scale of 1 (harm outweighs benefit) to 9 (benefit outweighs harm), to define appropriate use (median: 7 to 9), uncertain use (median: 4 to 6), and inappropriate use (median: 1 to 3) of endotracheal suction interventions. Scenarios were than classified as a level of appropriateness.ConclusionsThe RAND Corporation/University of California, Los Angeles Appropriateness Method provides a thorough and transparent method to inform development of the first appropriate use criteria for endotracheal suction interventions in paediatric patients.     

Flow transport and gas mixing during invasive high frequency oscillatory ventilation

A large Eddy simulation (LES) based computational fluid dynamics study was performed to investigate gas transport and mixing in patient specific human lung models during high frequency oscillatory ventilation. Different pressure-controlled waveforms (sinusoidal, exponential and square) and ventilator frequencies (15, 10 and 6 Hz) were used (tidal volume = 50 mL). The waveforms were created by solving the equation of motion subjected to constant lung wall compliance and flow resistance. Simulations were conducted with and without endotracheal tube to understand the effect of invasive management device. Variation of pressure-controlled waveform and frequency exhibits significant differences on counter flow pattern, which could lead to a significant impact on the gas mixing efficiency. Pendelluft-like flow was present for the sinusoidal waveform at all frequencies but occurred only at early inspiration for the square waveform at highest frequency. The square waveform was most efficient for gas mixing, resulting in the least wall shear stress on the lung epithelium layer thereby reducing the risk of barotrauma to both airways and the alveoli for patients undergoing therapy.     

“清醒”与静脉麻醉诱导状态光棒引导气管插管运用于困难气道的比较

摘 要 目的：比较“清醒”与静脉麻醉诱导状态光棒引导气管插管运用于困难气道的效果。方法: 将78 例困难气道患者随机分为清醒组和静脉麻醉诱导组,比较两组患者围术期生命体征的变化、气管导管插管时间及术毕气管导管拔管 1 h后咽喉部并发症情况。结果: 与气管插管前相比,静脉麻醉诱导患者插入气管导管后和拔除气管导管前血压、心率均显著上升（P＜0.05或P＜0.01）;与清醒组同阶段相比,差异也有统计学意义（P<0.05或P<0.01）。与静脉麻醉诱导组比较,清醒组患者插入气管导管所用时间明显缩短（P<0.01）,且术后24 h麻醉满意度明显提高（P<0.05）。结论: 与静脉麻醉诱导相比,“清醒”状态光棒引导气管插管运用于困难气道患者更具有优越性。