气囊漏气试验指导TARP内固定术后拔除气管导管的应用分析

The cuff-leak test on guiding the extubation after transoral atlantoaxial reduction and plate surgery

目的：研究气囊漏气试验（cuff-leaktest）对确定经口入路寰枢椎复位钢板（TARP）内固定手术后患者拔除气管导管时机的指导价值。方法：回顾2005年1月－2011年12月在我院行’rARP内固定手术后入OICU监护并拔除气管导管的患者。按判断拔管时机方式的不同分为气囊漏气试验指导拔管组（65例）和经验性拔管组（87例），前者主要根据气管导管气囊放松后以呼吸囊通气时咽喉部的气流声音决定患者能否拔管；后者通过观察患者舌体和咽后壁的肿胀程度决定能否拔管。比较两组患者的再插管率及术后带管时间。结果：气囊漏气试验指导拔管组再插管率为1．50％，经验性拔管组再插管率为3．40％，两者比较，差异无统计学意义（P〉0．05）。气囊漏气试验指导拔管组术后带管时间为：〈24h者27例、24～48h者29例、〉48h者9例，经验性拔管组术后带管时间为：〈24h者15例、24—48h者36例、〉48h者36例，两组相比有统计学差异（P〈0．01）。结论：对于TARP内固定术后患者，采用气囊漏气试验可以更为准确地判定拔管时机，较经验性拔管方法有效地缩短术后带管时间。

Objectives： To evaluate the effect of cuff-leak test on guiding extubatiorr after transoral atlantoaxial reduction and plate（TARP） surgery. Methods： From October 2008 to December 2011, the clinical data of patients experiencing TARP surgery were retrospectively reviewed. All cases were divided into two groups： cuff-leak-test-guided extubation group（n=65） and experience-guided extubation group（n=87）. The indication for cuff-leak-test-guided extubation was audible laryngopharyngeal air leak after deflation of the endotracheal tube balloon while ventilating by using an Ambu. While the indication for experience-guided extubation was the swelling degree of body of tongue and posterior wall of pharynx. The differences of reintubation rate and duration of postoperation intubation between 2 groups were compared. Results： There was no significant differ- ence in the reintubation rate between two groups （1.5% in the cuff-leak-test-guided extubation group and 3.40% in the experience-guided extubation group）（P〉0.05）. The duration of postoperation intubation in the cuff-leak-test-guided extubation group was much shorter than that in experience-guided extubation group（27 cases in 〈24h, 29 cases in 24-48h and 9 cases in 〉48h in the former group vs 15 cases in 〈24h, 36 cases in 24-48h and 36 cases in 〉48h in the latter, respectively, P〈0.01）. Conclusions： Compared with experience-guided extubation, cuff-leak test is more reliable to predict the exact time of extubation, which can effectively reduce the duration of postoperation intubation as well as ensure the safety of extubation after TARP surgery.