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[低损伤气管插管在超长期气管插管患者中的应用:一例报告]

[Application of low damage endotracheal intubation in patients undergoing extra long-term endotracheal intubation: a case report].

作者信息

Wang Hao, Ding Baochun

机构信息

Department of Anesthesiology, the Central Hospital of Huludao, Huludao 125000, Liaoning, China. Corresponding author: Ding Baochun, Email:

出版信息

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Jul;29(7):644-646. doi: 10.3760/cma.j.issn.2095-4352.2017.07.015.

DOI:10.3760/cma.j.issn.2095-4352.2017.07.015
PMID:28743345
Abstract

OBJECTIVE

To approach the effect of low damage endotracheal intubation on reducing the occurrence of cuff-related intubation complication and prolonging the intubation time.

METHODS

On January 7th, 2015, 1 patient with respiratory failure after subarachnoid hemorrhage were admitted to Huludao Central Hospital. Immediate endotracheal intubation and ventilator assisted ventilation were performed. When the trachea was difficult to be removed in a short time, and tracheotomy was refused, a low damage endotracheal intubation was used for a long term. On the basis of the original high volume low pressure cuff, this tube was designed for inner cuff, the hole was allowed in the inner cuff to connect with the tube. During the period of ventilation, the cuff pressure changed with airway pressure automatically, therefore it would reduce the compression injury of tracheal mucosa, improve the tolerance of the patients, and prolong the intubation time.

RESULTS

The patient was removed from the tube on October 12th, 2015 with an intubation day of 279, the intubation-related complications and severe aspiration pneumonia had not been observed during the application of low damage endotracheal intubation.

CONCLUSIONS

Design of this intubation ensured the cuff pressure changes with airway pressure, therefore, it could effectively avoid the cuff pressure become too high, and reduce the occurrence of intubation-related complication. This low damage endotracheal had an evident superiority in the aspects of cuff management. It has a better practical significance, especially for patients with long intubation time.

摘要

目的

探讨低损伤气管插管对减少套囊相关插管并发症的发生及延长插管时间的作用。

方法

2015年1月7日,1例蛛网膜下腔出血后呼吸衰竭患者入住葫芦岛市中心医院。立即行气管插管及呼吸机辅助通气。当短期内气管难以拔除且患者拒绝气管切开时,采用低损伤气管插管进行长期留置。该导管在原有大容量低压套囊的基础上,设计了内套囊,内套囊上有孔与导管相通。通气期间,套囊压力随气道压力自动变化,从而减少气管黏膜的压迫损伤,提高患者耐受性,延长插管时间。

结果

患者于2015年10月12日拔管,插管天数为279天,应用低损伤气管插管期间未观察到插管相关并发症及严重吸入性肺炎。

结论

该插管设计确保套囊压力随气道压力变化,因此能有效避免套囊压力过高,减少插管相关并发症的发生。这种低损伤气管插管在套囊管理方面具有明显优势。具有较好的实际意义,尤其对于插管时间长的患者。

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