一次性气管导管与金属导管联用在吸入性损伤患者应用中的生物相容性反应

Biocompatibility of one-off endotracheal tube combined with metal catheter for treating inhalation injury

背景:目前用于气管切开后的气管导管主要有一次性气管导管和金属导管2种,临床中发现各有优势与不足。目的:对比观察单用金属导管、单用一次性气管导管及联用一次性气管导管与金属导管在气管切开患者中应用的生物相容性反应。设计、时间及地点:回顾性分析,对照观察,于2008-12/2009-01在宜春市人民医院、南昌大学第一附属医院完成。对象:选择宜春市人民医院、南昌大学第一附属医院烧伤中心伴有吸入性损伤、作气管切开并行呼吸机支持的患者203例。其中1990/1997用金属导管患者85例为金属导管组,1998/2002用一次性气管导管患者62例为一次性气管导管组,2003-01/2008-11在应用呼吸机时用一次性气管导管而撤机后用金属导管患者56例为联用组。各组患者在性别、年龄、烧伤面积及吸入性损伤分型、治疗及呼吸机应用时间等方面差异无显著性意义(P>0.05)。方法:金属导管组患者一直采用金属导管外套气囊,一次性气管导管组患者应用一次性气管导管,联用组患者在应用呼吸机时采用一次性气管导管而撤机后用金属导管,应用金属导管时可每日拔出内导管清洗消毒4次。主要观察指标:观察各组患者在用管期间导管气囊破裂、脱落情况,计算各组患者气道出血例数、气管导管堵塞例数、撤机至拔管时间。结果:一次性气管导管组、联用组患者气囊破裂、脱落例数与出血例数少于金属导管组(P<0.05);金属导管组、联用组导管堵塞例数少于一次性气管导管组(P<0.05),拔管时间也较一次性气管导管组短,但差异无显著性意义(P>0.05)。结论:一次性气管导管与金属导管联用在吸入性损伤行气管切开患者中应用效果较单用效果好。

BACKGROUND： Either one-off endotracheal tube or metal catheter is frequently used for clinical therapy during recent years, individually comprising advantages and disadvantages. OBJECTIVE： To compare biocompatibilities of metal catheter alone, one-off endotracheal tube alone and combination between metal catheter and one-off endotracheal tube for clinical tracheotomy. DESIGN, TIME AND SETTING： A retrospective analysis and contrast study was performed in Yichun Municipal People＇s Hospital and the First Affiliated Hospital of Nanchang University between December 2008 and January 2009. PARTICIPANTS： A total of 203 patients with inhalation injury performed with tracheotomy and respirator were collected from Yichun Municipal People＇s Hospital and Burn Center of the First Affiliated Hospital of Nanchang University. All subjects were divided into three groups, including metal catheter group （n=85, from 1990 to 1997）, one-off endotracheal tube group （n=62, from 1998 to 2002）, and combination group （n=56, between January 2003 and November 2008）. There were no significant differences in sex, age, burning area, types of inhalation injury, therapeutic time, and supporting time of respirator between the three groups （P 〉 0.05）. METHODS： A balloon-attached metal catheter was used in the metal catheter group; an one-off endotracheal tube was used in the one-off endotracheal tube group; an one-off endotracheal tube ＋ metal catheter was used in the combination group. The inner catheter of the metal catheter could be pulled out for cleaning and disinfecting 4 times per day. MAIN OUTCOME MEASURES： Balloon rupture, catheter defluxion, and the numbers of patients with airway bleeding, endotracheal catheter blockage, as well as the time from respirator withdrawal to extubation. RESULTS： The numbers of cases with balloon rupture, catheter defluxion, and airway bleeding in the one-off endotracheal tube group and combination group were less than metal catheter group （P 〈 0.05）; the numbers of cases with catheter blockage in the metal catheter group and combination group were less than one-off endotracheal tube group （P 〈 0.05）; the extubation time was also shorter than combination group, but there was no significant difference （P 〉 0.05）. CONCLUSION： The therapeutic effect of one-off endotracheal tube combining with metal catheter is individually superior to one-off endotracheal tube and metal catheter alone.