摘要
目的比较传统测压方法与改进测压方法对气囊内压力的影响以及预防呼吸机相关性肺炎(VAP)的临床效果,为改进临床气囊管理提供理论依据。方法①实验研究:在气管模型上进行,分为传统测压组与改进测压组,传统测压组将测压表与指示气囊直接连接进行气囊压力检测;改进测压组通过在测压表上连接一个三通管锁定测压表压力为目标压力(32 cmH2O,1 cmH2O=0.098 kPa)后,再连接指示气囊检测。统计两种测压方法造成的压力损失及10 min内气囊上液体渗漏情况。②临床研究:采用历史性队列研究,选择2014年6月至2018年5月入住广西医科大学附属肿瘤医院重症加强治疗病房(ICU)行气管插管机械通气的患者为研究对象,以2016年5月底之前采用传统测压法的患者为对照组(249例),以2016年6月以后采用改进测压法的患者为观察组(314例)。两组均实施了预防VAP的集束化策略。比较两组患者VAP发生率、机械通气时间及ICU住院时间。结果①实验研究:传统测压组压力损失值为(10.18±0.47)cmH2O,改进测压组压力损失值为(1.33±0.42)cmH2O,两组比较差异有统计学意义(t=32.535,P=0.000)。传统测压组检测后10 min内气囊上液体全部渗漏,而改进测压组气囊上液体无明显渗漏。②临床研究:观察组VAP发生率虽较对照组有所降低,但差异无统计学意义〔5.10%(16/314)比8.43%(21/249),P>0.05〕。观察组机械通气时间和ICU住院时间较对照组明显缩短(d:9.93±3.14比16.77±5.45,11.63±2.28比19.12±5.10,均P<0.01)。结论改进测压方法可避免传统测压时气囊内压力明显下降以及可能造成的气囊上滞留物渗漏,结合集束化策略可明显改善机械通气患者的临床进程。
Objective To compare the intra cuff pressure changes during improved and the traditional method of cuff pressure measurement,then evaluate the effects of ventilator-associated pneumonia(VAP)prevention.The results highlighted practical recommendations in the process of ETT cuff pressure measurement.Methods①Experimental studies were carried out on the tracheal model with two groups:traditional pressure measurement group and improved pressure measurement group.The traditional pressure measurement group was connected to a handheld pressure gauge with the indicate cuff to get the intra-cuff pressure.The improved method was to insert a 3-way stopcock between the handheld pressure gauge and the indicate cuff.The 3-way stopcock to stabilize handheld pressure gauge reading at 32 cmH2O(1 cmH2O=0.098 kPa)before measure the intra-cuff pressure.The pressure loss caused by two pressure measurement methods and the leakage of liquid on the balloon after 10 minutes was compared.②Clinical researches:a historic cohort study,patients with mechanical ventilation(MV)admitted to intensive care unit(ICU)of Guangxi Medical University Cancer Hospital from June 2014 to May 2018 were enrolled.The control group(249 cases)was treated with traditional method during June 2014 to May 2016,and the observation group(314 cases)was treated with improved method during June 2016 to May 2018.Clusters of strategies and actions of VAP prevention were applied in both groups.Incidence of VAP,duration of MV,and the length of ICU stay were compared between the two groups.Results①Experimental study:the pressure leakage of the traditional pressure measurement group was(10.18±0.47)cmH2O,and that of the improved pressure measurement group was(1.33±0.42)cmH2O,with statistically significant difference between the two groups(t=32.535,P=0.000).All fluid on the cuffs leak after 10 minutes of traditional ways of measurement,however,no visible fluid on the cuffs leaked with improved procedures.②Clinical research:the incidence of VAP in the observation group was slightly lower than that in the control group,however there was no significant difference[5.10%(16/314)vs.8.43%(21/249),P>0.05].The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group(days:9.93±3.14 vs.16.77±5.45,11.63±2.28 vs.19.12±5.10,both P<0.01).Conclusion The improved procedures of intra-cuff pressure measurement is a practical method to avoid the pressure leakage and fluid leakage,and the clinical course of MV patients can be significantly improved by combining the clusters of nursing strategies and actions.
作者
黄玲
张丽凤
蒙丽英
周春锋
林景
黎阳
黄冰
陈英
Huang Ling;Zhang Lifeng;Meng Liying;Zhou Chunfeng;Lin Jing;Li Yang;Huang Bing;Chen Ying(Department of Critical Care Medicine,Guangxi Medical University Cancer Hospital,Nanning 530021,Guangxi Zhuang Autonomous Region,China;Nursing Department,Guangxi Medical University Cancer Hospital,Nanning 530021,Guangxi Zhuang Autonomous Region,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2019年第8期1024-1027,共4页
Chinese Critical Care Medicine
基金
广西医药卫生适宜技术开发与推广应用项目(S2018095)
广西壮族自治区卫生厅自筹经费科研课题(Z20170442).
关键词
改进测压法
气囊内压力
机械通气
呼吸机相关性肺炎
Improved ETT cuff pressure measurement procedure
Intra-cuff pressure of endotracheal tube
Mechanical ventilation
Ventilator-associated pneumonia
