徐静娴

[摘要] 目的 探讨人工气道气囊的最佳压力水平及气囊管理方法，为临床工作提供理论依据。 方法 选取2013年3月～2014年7月温州市中西医结合医院采用人工气道进行机械通气治疗的患者228例，测定不同气囊压力下气体的泄露和最小漏气技术下气囊的压力，确定气囊的最佳压力水平。 结果 随着气囊内的压力加大，气体泄露逐渐减少，气囊压力从10 cm H2O以每5 cm H2O增加，升高至40 cm H2O时，漏气例数从198例逐渐减少到18例。在最小漏气技术下，气囊压力值的差异比较大，当气囊压力值在5～10 cm H2O时，30例患者达到最小漏气的压力水平，每增加5 cm H2O，达到最小漏气压力水平的例数分别如下：10～15 cm H2O为37例、15～20 cm H2O为57例、10～25 cm H2O为24例、25～30 cm H2O为6例、30～35 cm H2O为18例、35～40 cm H2O为24例、40～45 cm H2O为12例、45～50 cm H2O为5例、50～55 cm H2O为6例、55～60 cm H2O为3例、60～65 cm H2O为3例和65～70 cm H2O为3例。 结论 气囊的压力值必须保持精准和狭小的范围来预防各种并发症。通过合理的选择插管型号、结合使用专用的气囊测仪器以及最小封闭压力技术充气，并加强气囊内压力的监测和调整等措施，可以更加完善人工气道患者气囊的管理，达到人工气道气囊最佳的充气量。

[关键词] 人工气道；气囊；最佳压力

[中图分类号] R614 [文献标识码] B [文章编号] 1673-7210（2015）02（b）-0161-04

[Abstract] Objective To explore the optimal pressure level of artificial airway gasbag and management method of gasbag， in order to provide a theoretical basis for the clinical work. Methods From March 2013 to July 2014， in Hospital of Traditional Chinese and Western Medicine of Wenzhou City， 228 patients with treatment of artificial airway mechanical ventilation were selected. The gas leakage under different air pressure and air pressure under the minimum leakage technology was determined， in order to determine the optimal level of pressure air bag. Results with the pressure inside the balloon increases， gas leakage decreased gradually， the gasbag pressure from 10 to 40 cm H2O with every 5 cm H2O increased， the number of leak from 198 cases gradually reduced to 18 cases. By the minimum leakage technology， the difference of gasbag pressure value was big， when the gasbag pressure value was 5-10 cm H2O， there were 30 patients reached the pressure level of minimum leakage， additional 5 cm H2O in each level， the number of patients with minimum leakage pressure levels were as follows： 37 cases when 10-15 cm H2O， 57 cases when 15-20 cm H2O， 24 cases when 10-25 cm H2O， 6 cases when 25-30 cm H2O， 18 cases when 30-35 cm H2O， 24 cases when 35-40 cm H2O， 12 cases when 40-45 cm H2O， 5 cases when 45-50 cm H2O， 6 cases when 50-55 cm H2O， 3 cases when 55-60 cm H2O， 3 cases when 60-65 cm H2O and 3 cases when 65-70 cm H2O. Conclusion By selecting the rational choice model， using the airbag intubation special measuring instrument and the technology of MOP inflatable， and strengthening the monitoring and adjusting cuff pressure and other measures， it can perfect aerocyst of artificial airway management， achieve the artifical airway ballonet optimal aeration quantity.

[Key words] Artificial airway； Gasbag； Optimum pressure人工气道是治疗呼吸衰竭最常用的方法，合理的气道管理能避免各种机械通气相关并发症的发生[1-2]。过高的气囊压力会导致气管内黏膜受压缺血、水肿、甚至糜烂，但气囊的压力过低，又会导致气道漏气，引发吸入性肺炎[3]。研究显示，人工气道气囊内的压力低于30 mm Hg（1 mm Hg=0.133 kPa），仅会造成气管黏膜轻微的病理改变，因此认为人工气管气囊内压力低于30 mm Hg为最佳[4]。……