| Objective: Investigation and application of high capacity and low pressure of endotracheal intubation, we monitored that the influence on tracheal stenosis for different sets of capsule pressure, observed the incidence of tracheal stenosis after intubation, analysised of causes of tracheal stenosis, and attempted to investigate the solution of decrease or prevetion of trracheal stenosis.Methods: 1 120 patients of, aged 18-70,collected from Respiratory Intensive Care Unit(RICU),ICU of the emergency department of the second hospital of Hebei Medical University, and Intensive Care Unit the fourth people’s hospital hengshui ntensive care unit, in January 2014 and January 2015.Thses cases were treated by high capacity and low-pressure of endotracheal intubation or traumatic mechanical ventilation for various reasons and extubated successfully. All collections were divided into observation group( ICU and emergency ICU of Second Hospital of Hebei Medical University,respiratory) and control group( anesthesia ICU and Hengshui Fourth Hospital ICU). There is no difference in the patients from two group in disease, age, gender. In daily work, the observation group patients after tracheal intubation with conventional air pressure gauge monitored and adjusted the air pressure, once every 8 hours, to ensure the air pressure between 25-30 cm H2O.we monitored the pressure by kneading gasbag in the control group without a set of capsule pressure gauge and feel the proximal tension, by experience entirely injecting gas, estimated capsule pressure within the normal range. The nursing staff were unified training from sputum and other related nursing. 1.1 monitoring of pressure of the cuff of two groups of patients in the test.The patients take half supine position.we applyed the endotracheal tube set of capsule pressure gauge to monitor the pressure, which the normal pressure is 25-30 cm H2O and The unit of measure is cm H2 O.Pressure for determination of endotracheal intubation of capsule, we connected the plug of the cuff pressure gauge to the connector of the cuff,reading the value. We recorded the collected patient’s age, gender, height, weight and diameter and endotracheal intubation time,respectively. 1.2 First,measured pressure of the cuff immediately after intubation that day(0), and then the third day, the 7th day,respectively. the value of the pressure of the cuff Should be recorded accurately. The full-time staff were responsibility for monitoring the presssure of the cuff of the cases and recorded the value of the pressure of the cuff of the patients intubated that day,which may be measured by the nurse of the patient,such as recorded the value and adjust it to the normal range timely when we found the cuff pressure is too high or too low high or too low during the measurement. 1.3 Checked neck-chest CT in 7th day, 15 th day after extubation,if we found tracheal stenosis, give the patien bronchoscope examination.If the patient have asthmatic symptom during this time,at any time review. And record site of the tracheal stenosis, the days of intubation, How long after extubation tracheal stenosis occurs stenosis.Observe the incidence of tracheal intubation in patients with tracheal stenosis. 1.4 Compare the accuracy of monitoring the pressure of the cuff between two methords and the incidence of tracheal stenosis. 2 Statistics processing: Data are expressed as means SE. Statistical analysis for multiple comparisons was performed with ANOVA for parametric data. Student’s t-test(for the VEGF assay) or the paired Student’s t-test(for the m RNA expression data) was employed. P values<0.05 were considered significant for all tests.Results: The first part: the list received mechanical ventilation for an average of 10 days, the average height(171 + 6) cm, average weight(69 + 12) kg, 76 patients(63%), endotracheal intubation tube diameter is 7.5, the other 44 patients(37%) pipe diameter tracheal intubation for 7, all patients were the breath tube intubation, and smooth tube drawing, 69 8 to 16 days intubation, 51 intubation 2 to 7 days.Two methods of monitoring capsule pressure, observation group have 1 set of capsule pressure is too high, then according to the pressure shown in the table will set of 30 cm H2Ocapsule pressure adjustment in the high normal range, the set of capsule flat, gradually increase the injection volume, until there is no air leakage monitoring pressure up to 50 sets of saccm H2 O. Pressure is less than 25 cm H2O, 3 cases of saccm H2O18 and 20 respectivelycm H2 O, 16 cm H2O.After continue to follow-up, has not been this group of patients with tracheal stenosis.Control group of 25 patients of capsule pressure is too high, average pressure of 56 cm H2O, 4 cases of tracheal stenosis occurs, there is no set of capsule in patients with low pressure.Applied pressure table monitoring capsule pressure accuracy is higher than the control group, observation group of tracheal stenosis rate of 0, the control group with hand knead airbag feeling method to set of capsule filling, the incidence of tracheal stenosis was 6.7%.Significantly higher than the observation group, after statistics processing, P < 0.05, the difference was statistically significant.Set of sac increased incidence of patients with tracheal stenosis rate 16%.The second part: the 69 cases of patients with intubation 8 to 16 days, 51 patients with intubation 2 to 7 days.2 cases patients with more than 10 days, intubation tracheal stenosis is more than 50%, after extubation soon for suppress symptoms.The other one cases of intubation time is shorter, less than 7 days, the tracheal stenosis 10%, 3 cases of stenosis site in airbag, 1 case at the bottom of the set of capsule.After statistics processing, endotracheal intubation in patients with 2 to 7 weather stenosis rate 2%.8-16 days of intubation tracheal stenosis rate 4%, intubation was positively correlated with the incidence of tracheal stenosis.Conclusions: 1 The application of balloon pressure measuring instrument for monitoring air pressure is more accurate, safety, lower incidence than the hand bag feeling method, there were significant differences in P<0.052 Days of intubation has a positive correlation with the incidence of tracheal stenosis.The longer the intubation time, the higher incidence of tracheal stenosis.3 Most strictures occur at the site of the tube cuff, few in the end.4 The early detection of tracheal stenosis after extubation, early treatment, it will not turn into severe tracheal stenosis.So after extubation, regular neck-chest CT scan is very necessary. |
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