控制气管导管套囊压力对全麻手术患者气管插管相关性并发症的影响:前瞻性、多中心、随机、双盲研究

目的 探讨控制气管导管套囊压力对全麻手术患者气管插管相关性并发症的影响.方法 本研究为前瞻性、多中心、随机、双盲研究.择期拟行全麻手术患者509例,ASA分级Ⅰ或Ⅱ级,年龄11～89岁,体重35～92kg,性别不限,随机分为2组:对照组(C组)和套囊压力测定组(CPM组),记录手术时间和带管时间.各组随机选取20例带管时间120～180 min的患者,于拔除气管导管时行纤维支气管镜检查.拔除气管导管后24 h内随访咳嗽及痰中带血等气管插管相关性并发症的发生情况.结果 两组患者年龄、性别构成比、手术时间及带管时间差异无统计学意义(P＞0.05).与C组比较,CPM组患者咽喉痛及痰中带血的发生率降低(P＜0.05);随带管时间延长,C组咽喉痛及痰中带血的发生率均升高,CPM组仅咽喉痛的发生率升高(P＜0.01).纤维支气管镜检查可见气管粘膜不同程度损伤,C组较CPM组严重.结论 控制气管导管套囊压力有助于减少全麻手术患者术后气管插管相关性并发症的发生.

Effect of measurement and adjustment of cuff-pressure of endotracheal tube on postoperative intubation-related complications:a prospective,multicenter,randomized,double-blind study

Objective To investigate the incidence of postoperative intubation-related complications and the need for measurement and adjustment of cuff-pressure of endotracheal tube. Methods Five hundred and nine patients of either sex undergoing elective surgery under general anesthesia with tracheal intubation were divided into 2 groups: control group (group C)and cuff-pressure measured group (group CPM). Operation time and duration of endotracheal tube were recorded. Twenty patients with the duration of endotracheal tube 120-180 min in each group were selected. Their tracheal mucous membrane was examined by fiberoptic bronchoscopy at the time of withdrawal of endotracheal tube. Postoperative complications including cough and bloody sputum were also recorded at 24 h after extubation. Results The two groups were comparable with respect to age, sex, operation time and the duration of endotracheal tube. The incidence of sore throat and bloody sputum was significantly higher in group C than in CPM group. The incidence of sore throat and bloody sputum was significantly increased as the duration of endotracheal tube was prolonged in control group while in CPM group only the incidence of sore throat was increased. Varying degrees of injuries to tracheal mucous membrane were observed with fiberoptic bronchoscope.The injuries were more serious in group C than in CPM group. Conclusion Measurement of intracuff pressure is helpful for reducing the tracheal intubation-related complications.