最低有效气管导管套囊压用于女性患者气管插管全麻腹腔镜手术的临床研究

Clinical study of minimum effective tracheal cuff pressure applied to laparoscopic surgery with general anesthesia and tracheal intubation in female patients

目的观察最低有效套囊压用于气管插管全麻腹腔镜手术的临床效果及安全性。方法择期行气管插管全麻腹腔镜手术的女性患者60例,按随机数字表法分为对照组和试验组,各30例,对照组应用手指感觉法给气管导管套囊充气,试验组应用最低有效套囊压法给套囊充气。记录两组患者套囊压;术毕拔除气管导管时行纤维支气管镜检查,观察气管黏膜损伤情况;记录拔除气管导管后套囊有无血迹及拔管后24 h内咽喉疼痛和声音嘶哑等气管插管相关并发症的发生情况。结果试验组患者套囊压为(9.07±5.38)cm H2O,明显低于对照组的(32.40±5.16)cm H2O(P<0.05);两组患者拔除气管导管后均未发生套囊血迹和声音嘶哑;两组患者拔除气管导管后24 h内咽喉疼痛发生率比较,差异无统计学意义(P>0.05);试验组气管黏膜散在点状充血发生率明显高于对照组(P<0.05),但局部片状充血发生率明显低于对照组(P<0.05)。结论最低有效气管导管套囊压用于气管插管全麻腹腔镜手术的女性患者临床效果好,对气管黏膜损伤小。

Objective To observe the clinical effect and safety of minimum effective tracheal cuff pressure applied to laparoscopic surgery with general anesthesia and tracheal intubation .Methods Sixty female patients undergoing selective laparoscopic surgery with general anesthesia and tracheal intubation were randomly divided into control group and experimental group ,with 30 cases in each group . Finger feeling method was adopted to cuff inflation in the control group ,while the method of minimum effective cuff pressure was adopted to cuff inflation in the experimental group.The cuff pressure of patients was recorded in two groups,bronchofiberscopy was performed following tracheal extubation after operation,the incidence of tracheal mucosa injury was observed ,and the incidence of cuff blood after tracheal extubation as well as the incidences of tracheal intubation-associated complications including throat pain and hoarseness within 24 hours after extubation was recorded.Results The experimental group gained a lower cuff pressure compared with the control group （[9.07 ＆#177;5.38] cmH2O vs.[32.40 ＆#177;5.16]cmH2O,P＆lt;0.05）.No cuff blood and hoarseness cases occurred in two groups ,and no significant difference was found in the incidence of throat pain within 24 hours after tracheal extubation between two groups （P＆gt;0.05）.The experimental group owned a significantly higher incidence of scattered petechial hyperemia in tracheal mucosa and a significantly lower incidence of local schistose hyperemia compared with the control group（P＆lt;0.05）.Conclusion The minimum effective tracheal cuff pressure applied to laparoscopic surgery with general anesthesia and tracheal intubation achieves better effects and less damages to tracheal mucosa in female patients .