自制改良式气管导管的临床应用研究

Study of improved tracheal tubes in the critical patients of ventilation

目的 探讨自制改良式气管导管在危重病患者机械通气时的临床应用效果。方法 将需要气管插管机械通气48 h以上的危重病患者随机分为对照组、治疗A组和治疗B组。所有患者均采用改良式气管导管经鼻气管插管,分别观察各组患者不同时间段改良式气管导管的气囊上方与声门下方之间滞留物总量和机械通气相关性肺炎(VAP)的发生情况,并对VAP相关因素和拔管后声音嘶哑的相关因素进行单因素和Logistic回归分析。结果 治疗B组插管后24 h改良气管导管气囊上方滞留物吸出总量较其他各组显著增多(P<0.01),治疗A组较对照组明显增多(P<0.05);对照组和治疗A组早发VAP发生率和晚发VAP发生率均明显高于治疗B组(P<0.01)。对照组拔管后声音嘶哑的发生率明显高于治疗A组和治疗B组(P<0.01)。开放气道后机械通气时间等多种因素与VAP和拔管后声音嘶哑的发生率成显著正相关,与吸出的气囊上方滞留物的量成显著负相关。结论 避免VAP的危险因素是降低VAP发生率行之有效的措施。自制改良式气管导管的临床应用,能有效地清除气囊上方滞留物,降低细菌在呼吸道定植率,是预防VAP比较有效的措施。

Objective To investigate practicability of improved tracheal tubes in the intubated - ventilated patients. Methods It used by advanced disquisitive method , the critical patients who needed to spile in tracheal and machine ventilation, were randomly divided into control group, treatment A group and treatment B group. All the patients used improved intubations. Sputum and subglottic secretion were measured by bacteriology every group, and morbidity of ventilator associated pneumonia(VAP) were an alysed. Results Subglottic secretion were more in 24 hours in treatment B group than in control group and treatment A group. Morbidity of voice hoarseness in the treatment A group and control group were significantly higher than those in treatment B group. There were significant differences between the treatment A group and treatment B group. Morbidity of VAP in control group was higher than that in treatment A group and treatment B group, and morbidity of late VAP in control group was higher than that in treatment A group and treatment B group. Conclusion Improved tracheal tubes can clear awaysubglottic sevretion,it' s one of the best and the most effective measure to prevent the VAP in the critical patients of ventilation. Application of improved tracheal tube can decrease morbidity of VAP.