三通接头在人工气道患者气囊压力监测中的应用

Application of three-way connection in air bag pressure monitoring in patients with artificial airway

目的探讨三通接头在人工气道气囊压力监测中的应用.方法采用便利抽样法,选择2016年8月-2017年7月入住沈阳市第四人民医院重症医学科建立人工气道进行机械通气的患者85例,均采用最小压力封闭技术向气囊注气封闭气道.随机分成两组.观察组(n=43)人工气道气囊连接三通接头,再连接气囊压力表监测气囊压力;对照组(n=42)人工气道直接连接气囊压力表监测气囊压力.监测两组患者充气后4、8、24、48 h气囊压力变化△P(△P=最小封闭压力-监测压力),观察患者返流误吸、气道黏膜损伤、肺部感染发生情况.结果两组充气4 h气囊压力变化差异无统计学意义[△P 4 h:(3.76±1.47)vs.(3.82±1.36)cmH2O,P>0.05],充气8、24、48 h观察组气囊压力变化较对照组小,差异均有统计学意义[△P 8 h:(5.76±2.58)vs.(7.29±2.42)cmH2O,24 h:(6.32±3.08)vs.(9.38±3.32)cmH2O,48 h:(8.79±5.26)vs.(15.32±5.87)cmH2O;P<0.01).观察组患者返流误吸发生率为9.3%,低于对照组的11.9%,差异有统计学意义(P<0.05);气道黏膜损伤及肺部感染发生率两组比较差异无统计学意义(P>0.05).结论使用三通接头可以有效减少人工气道气囊漏气现象,减少返流误吸的发生率.

Objective To explore the application of three-way connection in air bag pressure monitoring in patients with artificial airway. Methods Totally 85 patients who received artificial airway formechanical ventilation in the 4th People's Hospital of Shenyang from August 2016 to July 2017 were selected and randomized into two groups in whichminimum hermetically sealed pressure (MOP) was used in the air bag to seal the airway. The artificial airway balloon for the observation group (n=43) was connected to a balloon pressure meter by three-way connection to monitor the pressure in the balloon, while the artificial airway balloon for the observation group (n=42) was connected to a balloon pressure meter by direct connection to monitor the pressure in the balloon. The changes of balloon pressure (A P=MOP-monitoring pressure) at 4, 8, 24 and 48 h post air inflation were monitored in both groups. The incidence of regurgitation and aspiration, airway mucosal injury and pulmonary infection were observed in the two groups. Results There was no statistically significant difference in A P between the two groups at 4 h post air inflation[△ P 4 h:(3.76 ± 1.47)vs.(3.82 ± 1.36) cmH20;(P> 0.05) 1 The AP 8, 24 and 48 h of the observation group were lower than those of the control group, and there was statistically significant difference between the two groups [ A P 8 h:(5.76 ± 2.58)vs.(7.29 ± 2.42) cmH20;△ P 24 h:(6.32 ± 3.08) vs.(9.38 ± 3.32) cmH20;AP48 h:(8.79 ± 5.26) vs.(15.32 ± 5.87) cmH20;(P< 0.01)]. The incidence rate of regurgitation and aspiration in the observation group was 9.3%, lower than that in the control group, which was 11.9%, and there was statistically significant difference between the two groups (P<0.05);there was no statistically significant difference in the incidence rate of airway mucosal injury and pulmonary infection between the two groups (P > 0.05). Conclusions The use of three-way connection can reduce air leakage of the artificial airway balloon and reduce the incidence rate of regurgitation and aspiration effectively.