有囊气管导管在婴幼儿急性呼吸衰竭中应用的呼吸力学评价

The respiratory mechanics assessment of cuffed endotracheal tube in infants with acute respiratory failure

目的 探讨有囊气管导管在婴幼儿急性呼吸衰竭中的应用价值。方法 应用呼吸功能监测仪连续监测２１ 例用有囊气管内导管插管（ＣＥＴＴ组）和２５ 例用无囊气管内导管插管（ＵＥＴＴ组） 的急性呼吸衰竭患儿呼吸力学指标，并对比观察插管并发症的发生率。结果 插管当天ＣＥＴＴ组患儿的呼吸频率［（３６－２±２－２） 次／ｍｉｎ］ 、呼出潮气量［（９－５±０－５） ｍｌ／ｋｇ］、声门漏气率［（４－０±１－１）％ ］、呼吸功［（０－０６４ ±０－０２１）Ｊ／（ｍｉｎ·ｋｇ）］ ，与ＵＥＴＴ组［ 对应值分别为（３９－３ ±２－４） 次／ｍｉｎ、（８－６ ±０－８）ｍｌ／ｋｇ、（１４－０±１－２） ％ 、（０－０９２±０－０３５）Ｊ／（ｍｉｎ·ｋｇ）］ 相比，差异均有非常显著意义（Ｐ均＜ ０－０１） ；ＣＥＴＴ组呼吸系统顺应性［（０－５ ±０－３） ｍｌ／（ｃｍＨ２Ｏ·ｋｇ）］和阻力［（９３±５） ｃｍＨ２Ｏ／（Ｌ·ｓ）］ 与ＵＥＴＴ组［ 对应值为（０－６±０－３） ｍｌ／（ｃｍＨ２Ｏ·ｋｇ） 和（９４±５） ｃｍＨ２Ｏ／（Ｌ·ｓ）］ 相比，差异均无显著意义（ Ｐ均＞ ０－０５） ；ＵＥＴＴ组换管率多于ＣＥＴＴ组；两组导管保留时间、病死率、气压伤及拔管后喘鸣发生?

Objective To study the value of cuffed endotracheal tube (CETT) in infants with acute respiratory failure (ARF) Methods The indices of respiratory mechanics and complications in 21 infants intubated with CETT (CETT group) and 25 infants with uncuffed endotracheal tube (UETT group) were compared Results The mean values of respiratory rate [(36 2±2 2) time/min], expiratory tidal volume [(9 5±0 5)ml/kg], leak age% around the tube [(4 0±1 1)%] and work of breathing [WOB(0 064±0 021)J/(min·kg)] in CETT group were significantly different from the mean values [(39 3±2 4) time/min,(8 6±0 8) ml/kg, (14 0± 1 2)%,(0 092±0 035)J/(min·kg), respectively] in UETT group on the day of intubation (all P <0 01) The mean values of respiratory system compliance [(0 5±0 3) ml/(cmH 2O·kg)] and respiratory system resistance (93±5) cmH 2O/(L·s) in UETT group were not different from the corresponding mean values [(0 6±0 3) ml/(cmH 2O·kg) and (94±5) cmH 2O/(L·s), respectively] in CETT group ( P> 0 05) The incidence of re intubation in UETT group was higher than that in CETT group ( P< 0 01) There were more accidental extubation, endotracheal tube sliding into bronchus in UETT group than those in CETT group No significant differences in barotrauma, duration of intubation, post extubation stridor and mortality rate between the two groups were found Conclusion (1) The application of CETT in infants with ARF may decrease WOB during mechanical ventilation (2) Improved lung ventilation can be expected by reducing air leak around the CETT and increasing VTexp (3) The CETT was not associated with an increased risk of complications The CETT can be used safely in infants