鼻腔气管导管固定对经鼻气管插管患者鼻部压力的影响

The effect of nasal tube stabilization on pressure between tube and nose

目的:评估在平卧位和头颈部后仰位下鼻腔气管导管固定对经鼻气管插管患者鼻部压力的影响。方法:选取择期行口腔颌面外科手术经鼻腔气管插管的患者24例(ASA分级Ⅰ~Ⅱ级,年龄18~60岁),随机分为钢丝加强型(wire-reinforced,WR)气管导管和预铸直角弯度型(Ring-Adair-Elwyn,RAE)气管导管2组,进行气管插管。采用薄膜压力传感器测量患者导管固定前、后平卧位和后仰位导管与鼻部间的压力。采用Graphpad Prism 9.0软件包对数据进行统计学分析。结果:导管固定前,WR导管与鼻部间的压力在平卧位时比RAE导管高51 mmHg(P=0.005),后仰位时比RAE导管高68 mmHg(P=0.0007)。WR组导管固定前,后仰位比平卧位压力增加24 mmHg(P=0.0005);导管固定后,平卧和后仰位压力未见统计学差异(P=0.1514),导管固定显著降低平卧位(P=0.0005)和后仰位(P=0.0005)时导管与鼻部间的压力。RAE组导管固定前,平卧和后仰位导管与鼻部间的压力无统计学差异(P=0.3394);导管固定后,平卧位和后仰位压力也无统计学差异(P=0.7910),导管固定显著降低平卧位(P=0.0005)和后仰位(P=0.0005)时导管与鼻部间的压力。结论:无论平卧位还是后仰位,导管固定均可有效降低WR气管导管和RAE导管对鼻部的压力。与WR气管导管相比,RAE导管可显著降低对鼻部的压力。

PURPOSE:This clinical trial was performed to evaluate the effect of nasal tube stabilization(NTS)on pressure between tube and nose(PTN)in both supine and neck extension position.METHODS:Twenty-four ASAⅠorⅡadult patients scheduled for oral and maxillofacial surgeries requiring naso tracheal intubation(NTI)were randomly assigned to intubate with either wire-reinforced or Ring-Adair-Elwyn tube.Thin film pressure sensor was used to measure PTN before and after NTS in both supine and neck extension position.Statistical analysis was performed with Graphpad Prism 9.0 software package.RESULTS:The PTN of wire-reinforced tubes were 51 mmHg higher than that of RAE tubes in supine position before NTS(P=0.005),and 68 mmHg higher than that in extension position before NTS(P=0.0007).In wire-reinforced tube group before NTS,the PTN of neck extension position increased by 24 mmHg compared with supine position(P=0.0005).After NTS,the PTN in supine and neck extension position was comparable(P=0.1514).NTS significantly reduced PTN in both supine(P=0.0005)and neck extension position(P=0.0005);while in RAE tube group before NTS,the PTN in supine and neck extension position was comparable(P=0.3394).After NTS,the pressure in supine and neck extension position was comparable(P=0.7910).NTS also significantly reduced PTN in both supine(P=0.0005)and neck extension position(P=0.0005).CONCLUSIONS:NTS effectively reduced PTN of both wire-reinforced and RAE tubes regardless of supine or neck extension position.RAE tube also significantly reduced PTN compared with wire-reinforced tube.