Gaynor E B
Department of Surgery, Norwalk Hospital, CT.
Laryngoscope. 1988 Sep;98(9):972-9. doi: 10.1288/00005537-198809000-00012.
Significant complications are encountered in some patients as a result of prolonged endotracheal intubation. The finding of low gastric pH values at postmortem examination in patients whose larynx was severely traumatized after endotracheal intubation suggested that gastroesophageal reflux (GER) is an important factor in the pathogenesis of these problems. To evaluate the occurrence and character of GER as well as its effects upon the larynx and trachea of intubated patients, clinical observations and several animal models were employed. Monitoring of pH values for GER was performed in intubated patients both in the operating room and the intensive care unit with a 40% incidence of GER in ICU patients not receiving antacid therapy. After exposure to gastric juice, marked inflammation and necrosis were observed in the larynx of rabbits, and a significant reduction of mucociliary flow was found to occur in the dog's trachea. The physiology and mechanisms of these events are discussed and indicate that GER may play an important role in the development of permanent laryngeal and tracheal injury in the intubated patient. It is recommended that pharyngeal pH be monitored in intubated patients because their altered state of consciousness may predispose to gastric reflux. When GER is encountered, initiation of treatment should be undertaken because prevention is considerably more effective than subsequent treatment.
一些患者因气管插管时间延长而出现严重并发症。在气管插管后喉部严重创伤的患者尸检中发现胃内pH值较低,这表明胃食管反流(GER)是这些问题发病机制中的一个重要因素。为了评估GER的发生率和特征及其对插管患者喉部和气管的影响,采用了临床观察和几种动物模型。在手术室和重症监护病房对插管患者进行GER的pH值监测,未接受抗酸治疗的ICU患者中GER发生率为40%。兔子喉部暴露于胃液后,观察到明显的炎症和坏死,并且发现狗的气管中黏液纤毛流动显著减少。对这些事件的生理机制进行了讨论,表明GER可能在插管患者永久性喉和气管损伤的发生中起重要作用。建议对插管患者监测咽部pH值,因为他们意识状态的改变可能易导致胃反流。当遇到GER时,应开始治疗,因为预防比后续治疗有效得多。