改良Maury气囊漏气试验在成人拔管前评估咽喉通道的应用

Application of modified Maury cuff-leak test to evaluate laryngeal passage before extubation

目的探讨改良Maury气囊漏气试验方法及在成人气管插管延迟拔管前评估咽喉通道的临床价值。方法对103例成人重度阻塞性睡眠呼吸暂停综合征(OSAHS)患者及2例气管闭塞段切除端吻合术后延迟拔管患者进行改良Maury气囊漏气试验。漏气量>120 ml为阴性组,<120 ml者为阳性组,观察两组拔管后的呼吸情况及处理对策。结果改良Maury气囊漏气试验阴性组83例,均成功拔管。阳性组22例,局部肿胀者8例消肿后成功脱管;喉腔偏小或插管管径偏大5例,拔管后3例通畅,2例呼吸困难置口咽通气道后脱管;气囊移位或皱襞2例,成功拔管;分泌物滞留喉腔4例,吸除后转为阴性;近苏醒喉痉挛3例,1例镇静后转阴性,1例重新插管,1例置口咽通气道后脱管。结论改良Maury气囊漏气试验阴性可作为成人延迟拔管者咽喉气道通畅指标;阳性者须确定为假性狭窄,备好口咽通气道和做好再插管准备后才能拔管。

OBJECTIVE To study the clinical value of modified Maury cuff-leak test in the evaluation oflaryngeal passage before extubation in delayed extubation patients. METHODS Modified Maury cuff-leak test was used in 103 cases of severe OSAHS patients and 2 cases of tracheal occlusion resection patients with delayed extubationt. Air leakage 〉 120 ml was defined as negative group, and otherwise was defined as positive group. The patients’ breathing condition and countermeasures were observed. RESULTS There were 83 cases in negative group and 22 cases in positive group.After extubation,all of the patients in the negative group breathed well. But in positive group, 8 cases were with local swelling turned into negative after detumescence treatment; Five cases were with small laryngeal cavity or large diameter of tracheal intubation, 3 cases were normal after extubation,other 2 cases needed oropharyngeal airway to breath;Two cases with tube dislocation or airbag fold were extubated successfully; 4 cases with sticky secretion on the supraglottis area were detached successfully after secretion aspiration; 3 cases with laryngeal spasm, 1 was detached by using oropharyngeal airway, 1 by reintubation, and the last1 by sedative treatment. CONCLUSION According to the modified Maury cuff-leak test, the negative can be regarded as an indicator of laryngeal airway patency in delayed extubation patients. For the positive, we should exclude the narrow airway, prepare oropharyngeal airways and get ready to reintubation before extubation in the delayed extubation patients.