单纯加大气管插管导管套囊压力能导致兔气管狭窄吗？

Only increasing cuffed pressure can lead to postintubation tracheal stenosis in rabbit？

【摘要】目的探讨单纯加大气管插管导管套囊压力能否导致兔气管狭窄。方法对10只新西兰兔行气管插管并持续6h，通过体外颈部超声和组织病理学检查，观察不同的套囊充气压力（25mmHg，50mmHg，100mmHg，150mmHg，200mmHg）于气管插管后12周气管腔的形态、内径及组织学变化。结果所有实验兔在插管期间无出现气管破裂或窒息等并发症，拔管后均无出现喘息、呼吸困难或意外死亡等情况。体外高频超声和游标卡尺测量气管左右径、气管前壁厚度均具有良好的相关性（分别r=0．884，P〈0．01和r=0．923，P〈0．01）；体外颈部超声测量实验兔插管前和拔管后12周气管左右径分别为（5．18±0．29）mm和（4．93±0．47）mm，差异无统计学意义（t=2．041，P〉0．05）；气管前壁厚度分别为（0．69±0．11）mm和（0．75±0．12）mm，差异无统计学意义（t=1．049，P〉0．05）。12周后压迫段气管壁炎症反应与套囊压力之间呈明显正相关（r=0．978，P〈0．01）。组织病理学检查表明增大套囊压力气管插管，拔管12周后气管腔无塌陷，软骨膜完整、软骨无破坏，未见瘢痕（肉芽）组织增生。结论在-定的导管型号和留置插管时间条件下，单纯加大气管插管导管套囊压力并不能导致兔气管狭窄，套囊内充气压力并非为插管后并发气管狭窄的唯-危险因素，因此有必要进一步综合研究其他相关因素。

Objective To investigate weather only increasing cuffed pressure could cause traceal stenosis in rabbit. Methods Ten New Zealand rabbits were received endotracheal intubation for 6 hours with different cuff pressure （25, 50, 100, 150, 200 mmHg）, the change of tracheal diameter and morphology were detected 12 weeks after extubation by ultrasound and histological examination. Results Tracheal fracture or apnea did not occur during intubation,no rabbit appeared wheeze,dyspnea or even die after extubation. We found a significant correlation between ultrasound and vernier caliper to measure the tracheal diameter and the thickness of interior tracheal wall （ r =0. 884, P ±0.01 and r =0. 923, P〈 0.01,respectively）. The tracheal diameter measured by ultrasound pre intubation and 12 weeks after extubation were （5.18±0.29） mm and （4.93±0.47） mm,respectively （t =2. 041, P〉0.05）. While the thickness of interior tracheal wall were （0.69 ± 0.11） mm and （0.75 ± 0.12） mm, respectively （ t= 1. 049, P 〉0.05）. Significant correlation was found between cuff pressure and grade of inflammation （ r =- 0. 978, P〈0.01）. Histological examination showed no evidence of cartilage damaged and granulation tissue overgrew. Conclusions In the condition of fixed endotracheal tube and the intubation duration,only increasing the cuffed pressure could not cause tracheal stenosis in rabbit, and the cuffed pressure is not the only risk factor of postintubation tracheal stenosis, thus it is necessary to explore further the other relevantfactors.