机械通气患者持续气囊压力监测的临床研究

发布时间：2018-01-10 05:34

本文关键词：机械通气患者持续气囊压力监测的临床研究　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:建立人工气道行机械通气是救治危重患者生命的重要措施,气囊管理则是人工气道管理的重要内容。合理有效的气囊管理对防止机械通气时气道漏气,保证有效通气量;避免口腔分泌物、胃内容物误入气道引发呼吸机相关性肺炎;防止气道粘膜损伤都有非常重要的意义。本次研究通过体外实验与临床研究相结合的方法,体外实验部分应用压力传感器与气囊测压表同时测量气囊压力,以判断压力传感器监测气囊压力值的准确性;在临床应用压力传感器持续监测过程中分析吸痰、翻身、口腔护理及吞咽对气囊压力的影响,观察气囊压力随时间的变化规律,探讨该持续监测方法的临床可行性,是否值得临床推广。方法:1体外实验部分通过三通分别连接压力传感器及气囊测压表,两种测压方法同时测量不同体积及不同型号气囊的压力,并对测压值进行比较。2临床实验部分通过压力传感器和三通及一个30cm长的延长管与气管导管外露气囊相连,压力传感器与PHILIPS床旁监护仪相连,通过监护仪持续监测气囊压力。进行气囊压力校正时要求患者取半卧位,床头抬高30度,头部为正中位,气囊充气至25cm H20,应用听诊器听诊,确定无气道漏气。监护仪报警设置为低限20cm H20,高限30cm H20。持续监测数据每隔30分钟记录一次。临床活动包括吸痰、翻身及口腔护理,要求记录活动前、活动时、活动后5分钟、活动后15分钟、活动后30分钟的气囊压力;另外,记录吞咽前、吞咽时、吞咽后1分钟、吞咽后5分钟、吞咽后10分钟的气囊压力。结果:1体外实验证实压力传感器测量值与气囊测压表的测量值经配对t检验分析差异无统计学意义,t=0.781,P=0.449。2吸痰时气囊压高于吸痰前气囊压,差异有统计学意义,吸痰时气囊压为39.28±15.14cm H20,已超过30cm H20;吸痰后5分钟气囊压略高于吸痰前气囊压,差异有统计学意义;吸痰后15分钟、吸痰后30分钟与吸痰前气囊压力值差异无统计学意义。3翻身前与翻身时气囊压力值差异有统计学意义(P0.05),翻身时气囊压力高于翻身前气囊压力值;翻身前与翻身后5分钟气囊压力值差异有统计学意义,翻身后5分钟气囊压力略高于翻身前气囊压力值,但翻身后5分钟气囊压力并未超过30cm H2O;翻身前与翻身后15分钟、翻身后30分钟气囊压力值差异无统计学意义。4口腔护理前与口腔护理时气囊压力值差异有统计学意义(P0.05),口腔护理时气囊压力高于口腔护理前气囊压力值;口腔护理前与口腔护理后5分钟、15分钟、30分钟气囊压力值差异无统计学意义。5吞咽前与吞咽时气囊压力值差异有统计学意义(P0.05),吞咽时气囊压力高于吞咽前气囊压力值;吞咽前与吞咽后1分钟、5分钟、10分钟气囊压力值差异无统计学意义。6持续监测数据中不同时间点的气囊压采用重复测量的方差分析,F=8.367,P=0.001,各时间点的气囊压力值存在统计学差异,即至少有两个时间点间存在差异。从各时间点气囊压力值进行两两比较结果及气囊压力均值绘制图可以看出,气囊压会随着时间的推移逐渐下降。结论:1应用压力传感器可以准确监测气囊压。2临床活动会导致气囊压出现短暂性升高,瞬时压力增高会误导工作人员对气囊压力值安全性的判断,不可盲目抽气降低气囊压以免增加漏气和误吸的风险。3气囊存在微漏气,气囊压会随着时间的推移逐渐下降,建议每8h校正一次气囊压,为气囊补气。4使用压力传感器能持续动态监测气囊压,保证气囊压处于控制范围,值得临床推广。
[Abstract]:Objective: to establish artificial airway and mechanical ventilation is an important measure for the treatment of critically ill patients life, balloon management is an important content of management of artificial airway gasbag management. Reasonable and effective to prevent mechanical ventilation airway leakage, ensure effective ventilation; avoid oral secretions, stomach contents into the airway causing ventilator-associated pneumonia; prevention is very the important significance of airway mucosal injury. Methods this study combined with clinical study of in vitro experiments, in vitro experiments of pressure sensor and airbag pressure gauge measurement at the same time balloon pressure, to determine the accuracy of monitoring air pressure value of the pressure sensor; suction, turning analysis in clinical application process of continuous monitoring of pressure sensor, influence oral nursing and swallowing of air pressure and air pressure were changing with time, to explore the continuous monitoring method of Pro The bed is feasible, whether it is worthy of clinical promotion. Methods: 1 in vitro through three links are respectively connected with the pressure sensor and the air pressure gauge, simultaneous measurement of different size and different types of air pressure of two kinds of measuring method for pressure, and compare the value of.2 part of clinical trials and three pass through a pressure sensor and a 30cm long prolonged tracheal catheter is connected with the exposed tube, pressure sensor and PHILIPS bedside monitor is connected, through continuous monitoring of air pressure monitor. The air pressure correction when patients were asked to take a semi recumbent, head elevation of 30 degrees, the head to the middle, inflated to 25cm H20, the application of stethoscope auscultation, no airway leak. Monitor the alarm is set to low limit high limit 30cm 20cm H20, H20. continuous monitoring data recorded every 30 minutes. The clinical activities include suctioning, turning and oral care requirements recorded before the event, live When, 5 minutes after the event, 15 minutes after the event, the air pressure 30 minutes of activity; in addition, the record before swallowing, swallowing, swallowing after 1 minutes, 5 minutes after swallowing, the air pressure 10 minutes after swallowing. Results: 1 in vitro experiments confirmed that the pressure sensor measurements by paired t test analysis of differences no statistical significance, t=0.781 and air pressure gauge measurement value of P=0.449.2 when the pressure is higher than air suction suction before air pressure, the difference was statistically significant, when the suction air bag pressure was 39.28 + 15.14cm H20, 30cm has more than H20; 5 minutes after suctioning air pressure slightly higher than before the suction air bag pressure, have statistically significant differences; 15 minutes after suctioning, 30 minutes after suctioning and suction before the air pressure value was no significant difference between.3 and turning the air pressure before turning over the value of the difference was statistically significant (P0.05), turning the air pressure is higher than the gas pressure value before turning capsule; before turning and turning 5 minutes after the air pressure difference has statistical significance, over 5 minutes after the air pressure is slightly higher than that of turning the front airbag pressure value, but turn over 5 minutes after the air pressure does not exceed 30cm H2O; turn over before and after turning over 15 minutes, 30 minutes after turning the air pressure value had no significant difference between.4 and oral care before and oral care when the air pressure difference was statistically significant (P0.05), when air pressure is higher than the oral care oral care before the air pressure value; oral care oral care before and after 5 minutes, 15 minutes, 30 minutes of air pressure had no significant difference between the.5 and the swallow before swallowing air pressure value were statistically significant (P0.05) when the air pressure is higher than that of swallowing before swallowing air pressure value; before swallowing and swallowing after 1 minutes, 5 minutes, 10 minutes of air pressure value of the difference was not statistically significant.6 balloon continuous monitoring data at different time point pressure Using repeated measures analysis of variance, F=8.367, P=0.001, there was a significant difference between the values of air pressure at each time point, that there exist at least two time points. The difference between the result and the comparison of mean air pressure drawing 22 from each time point of the air pressure value can be seen, the air bag pressure will gradually decreased with time. Conclusion: 1 the application of pressure sensor can accurately monitor the air pressure.2 clinical activity can lead to air bag pressure transient increase, the instantaneous pressure increased to mislead the staff safety value judgment on the air pressure, not blindly pumping gas to reduce the risk of.3 balloon cuff pressure to avoid increasing the leakage and aspiration of the existence of micro leakage, air pressure gradually decreased over time, every school is 8h times for.4 air balloon balloon pressure, a pressure sensor using continuous dynamic monitoring can ensure air pressure in the air bag pressure, control range, It is worthy of clinical promotion.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472

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