不同气管导管套囊压力对颈部手术后患者咽部症状的影响

The Effect of Cuff Pressure of Two Endotracheal Tubes on Pharyngeal Symptoms After Cervical Surgery

目的探讨不同气管导管套囊压力对患者术后咽部症状的影响。方法选择2016年1—4月择期行颈部手术患者50例,采用随机数字表法分为NIM组27例(使用NIM喉返神经功能监测导管)和Rusch组23例(使用Rusch加强型气管导管)。两组患者常规麻醉诱导并气管插管后将套囊充气至20 mmHg,采用压力传感器连续记录导管套囊压力,每5 min取值1次直至拔管。术后24 h回访患者咽痛、咽干情况并分析相关因素。结果与Rusch组相比,气管插管后NIM组达到相同套囊压力所需充气量较少(P <0. 05); NIM组导管套囊压力为(31. 1±9. 5) mmHg显著高于Rusch组的(23. 7±8. 5) mmHg,差异有统计学意义(P <0. 01)。NIM组咽痛视觉模拟评分(VAS)评分为(4. 0±2. 0)分显著高于Rusch组的(2. 6±1. 4)分,差异有统计学意义(P <0. 01);单因素分析显示,术后咽痛VAS评分与平均套囊压力相关(β=0. 391,SE=0. 162,P=0. 020)。两组术后咽干分级比较差异无统计学意义(P> 0. 05);单因素分析未发现咽干分级影响因素;决策树模型分析显示:当套囊压力<24. 06 mmHg时Ⅰ级咽干概率最高,当24. 06 mmHg≤套囊压力<28. 35 mmHg时Ⅲ级咽干概率最高,当套囊压力≥28. 35 mmHg时Ⅳ级咽干概率最高。结论颈部手术术后咽痛与气管导管平均套囊压力有关,NIM气管导管术后咽部症状程度轻于Rusch气管导管,气管导管套囊压力控制在<24. 06 mmHg时咽部症状控制最佳,故推荐颈部手术术中持续监测套囊压力。

Objective To explore the eflect of cuff pressme of two endotracheal tubes （EET） on pharyngeal symptoms after cmw-ical surgry. Methods Fifty patients who underwent cervical surgry in our hospital between Janual7 2016 to April 2016 were included. They were randomly divided into NIM group （ using NIM tube to monitor rectorent laryngeal nmw-e, n = 27 ） and Rusch group （ using Rusch enhanced endotracheal tube, n = 23 ）. After in- duction of general anesthesia and endotracheal intubation, the cuff pressure was inflated to 20 mmHg. Cuff pressure was rectodeal evel＇/5 rain using a pressure transducer until extubation. Sore throat and all-/throat were assessed and graded by VAS 24 h after surgery. Results Compared with the Rusch group, the NIM group required less inflation to achieve the same cuff pressure after tracheal intubation （ P 〈 0.05 ）. The NIM group showed higher cuff pressure than Rusch group [ （31.1 .＋ 9.5 ） mmHg vs （23.7 .＋ 8.5 ） mmHg, P 〈 0.01 ]. The N1M group got higher VAS score for sore throat than the Rusch group （4.0 _＋2.0 vs 2.6 _＋ 1.4, P 〈0.01 ）. Univariate analysis found that average cuff pressure had an obvious eflect on VAS score for sore throat （]9 =0. 391 ,SE =0. 162, P =0. 020）. There was no significant diflerence in the postoperative dl7- throat grading in the two groups（P 〉 0.05 ）. After univariate analysis, the factors afleeting dl7- throat grading were not found. Decision tree model analysis showed that the probability of grade I dl7- throat level was the highest when cuff pressure was 〈 24. 06 mmHg; when cuff pressure was /〉 24.06 mmHg and 〈 28. 35 mmHg, the probability of level I][ was the highest; when cuff pressure was /〉 28.35 mmHg, the probability of level IV were the highest. Conclusion Sore throat after cmw-ical surgry was relat- ed to the average cuff pressure of the tracheal tube. There was no erarelation between the postoperative pharyngeal grading and the average cuff pressure. Continuous monitoring of cuff pressure during cervical surgel＇/is recommended to improve anesthesia quality and reduce the incidence of perioperative complications.