Cheng Kuo-Chen, Hou Ching-Cheng, Huang Heng-Ching, Lin Shu-Chih, Zhang Haibo
Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Crit Care Med. 2006 May;34(5):1345-50. doi: 10.1097/01.CCM.0000214678.92134.BD.
To determine whether treatment with corticosteroids decreases the incidence of postextubation airway obstruction in an adult intensive care unit.
Clinical experiment.
Adult medical and surgical intensive care unit of a teaching hospital.
One hundred twenty-eight patients who were intubated for >24 hrs with a cuff leak volume <24% of tidal volume and met weaning criteria.
: Patients were randomized into a placebo group (control, n = 43) receiving four injections of normal saline every 6 hrs, a 4INJ group (n = 42) receiving four injections of methylprednisolone sodium succinate, or a 1INJ group (n = 42) receiving one injection of the corticosteroid followed by three injections of normal saline. Cuff volume was assessed 1 hr after each injection, and extubation was performed 1 hr after the last injection. Postextubation stridor was confirmed by examination using bronchoscopy or laryngoscopy.
The incidences of postextubation stridor were lower both in the 1INJ and the 4INJ groups than in the control group (11.6% and 7.1% vs. 30.2%, both p < .05), whereas there was no difference between the two treated groups (p = .46). The cuff leak volume increased after the second and fourth injection in the 4INJ group and after a second injection in the 1INJ group compared with the control group (both p < .05).
A reduced cuff leak volume is a reliable indicator to identify patients at high risk to develop stridor. Treatment with a single or multiple injections of methylprednisolone can effectively reduce the occurrence of postextubation stridor.
确定在成人重症监护病房中，使用皮质类固醇治疗是否可降低拔管后气道梗阻的发生率。
临床实验。
一家教学医院的成人内科和外科重症监护病房。
128例插管超过24小时、套囊漏气量小于潮气量24%且符合撤机标准的患者。
患者被随机分为安慰剂组（对照组，n = 43），每6小时接受4次生理盐水注射；4次注射组（n = 42），接受4次琥珀酸钠甲泼尼龙注射；或1次注射组（n = 42），接受1次皮质类固醇注射，随后3次注射生理盐水。每次注射后1小时评估套囊容积，最后一次注射后1小时进行拔管。通过支气管镜或喉镜检查确认拔管后喘鸣。
1次注射组和4次注射组拔管后喘鸣的发生率均低于对照组（分别为11.6%和7.1%，而对照组为30.2%，p均<0.05），而两个治疗组之间无差异（p = 0.46）。与对照组相比，4次注射组在第2次和第4次注射后以及1次注射组在第2次注射后套囊漏气量增加（p均<0.05）。
套囊漏气量减少是识别发生喘鸣高危患者的可靠指标。单次或多次注射甲泼尼龙治疗可有效降低拔管后喘鸣的发生率。
