鼻腔气管导管固定对经鼻气管插管患者鼻部压力的影响

doi:10.19438/j.cjoms.2021.04.011

中国口腔颌面外科杂志 ›› 2021, Vol. 19 ›› Issue (4): 345-349.doi: 10.19438/j.cjoms.2021.04.011

鼻腔气管导管固定对经鼻气管插管患者鼻部压力的影响

胡文月, 吕翔^*, 孙宇^*

上海交通大学医学院附属第九人民医院麻醉科,上海 200011

收稿日期:2021-02-25 修回日期:2021-03-19 出版日期:2021-07-20 发布日期:2021-08-05
通讯作者: 吕翔,E-mail：mzklvxiang@163.com;孙宇,E-mail：dr_sunyu@163.com。^*共同通信作者
作者简介:胡文月（1995-）,女,在读硕士研究生,E-mail：huwenyue08@163.com
基金资助:
上海交通大学医学院附属第九人民医院“交叉基金”（JYJC201916）

The effect of nasal tube stabilization on pressure between tube and nose

HU Wen-yue, LYU Xiang, SUN Yu

Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2021-02-25 Revised:2021-03-19 Online:2021-07-20 Published:2021-08-05

摘要/Abstract

摘要： 目的： 评估在平卧位和头颈部后仰位下鼻腔气管导管固定对经鼻气管插管患者鼻部压力的影响。方法： 选取择期行口腔颌面外科手术经鼻腔气管插管的患者24例（ASA分级Ⅰ~Ⅱ级,年龄18~60岁）,随机分为钢丝加强型（wire-reinforced,WR）气管导管和预铸直角弯度型（Ring-Adair-Elwyn,RAE）气管导管2组,进行气管插管。采用薄膜压力传感器测量患者导管固定前、后平卧位和后仰位导管与鼻部间的压力。采用Graphpad Prism 9.0软件包对数据进行统计学分析。结果： 导管固定前,WR导管与鼻部间的压力在平卧位时比RAE导管高51 mmHg （P=0.005）,后仰位时比RAE导管高68 mmHg （P=0.0007）。WR组导管固定前,后仰位比平卧位压力增加24 mmHg （P=0.0005）;导管固定后,平卧和后仰位压力未见统计学差异（P=0.1514）,导管固定显著降低平卧位（P=0.0005）和后仰位（P=0.0005）时导管与鼻部间的压力。RAE组导管固定前,平卧和后仰位导管与鼻部间的压力无统计学差异（P=0.3394）;导管固定后,平卧位和后仰位压力也无统计学差异（P=0.7910）,导管固定显著降低平卧位（P=0.0005）和后仰位（P=0.0005）时导管与鼻部间的压力。结论： 无论平卧位还是后仰位,导管固定均可有效降低WR气管导管和RAE导管对鼻部的压力。与WR气管导管相比,RAE导管可显著降低对鼻部的压力。

关键词: 鼻翼, 气管导管, 气管内插管, 压力, 溃疡

Abstract: PURPOSE: This clinical trial was performed to evaluate the effect of nasal tube stabilization (NTS) on pressure between tube and nose(PTN) in both supine and neck extension position. METHODS: Twenty-four ASAⅠorⅡ adult patients scheduled for oral and maxillofacial surgeries requiring naso tracheal intubation(NTI) were randomly assigned to intubate with either wire-reinforced or Ring-Adair-Elwyn tube. Thin film pressure sensor was used to measure PTN before and after NTS in both supine and neck extension position. Statistical analysis was performed with Graphpad Prism 9.0 software package. RESULTS: The PTN of wire-reinforced tubes were 51 mmHg higher than that of RAE tubes in supine position before NTS (P=0.005), and 68 mmHg higher than that in extension position before NTS (P=0.0007). In wire-reinforced tube group before NTS, the PTN of neck extension position increased by 24 mmHg compared with supine position (P=0.0005). After NTS, the PTN in supine and neck extension position was comparable (P=0.1514). NTS significantly reduced PTN in both supine (P=0.0005) and neck extension position (P=0.0005); while in RAE tube group before NTS, the PTN in supine and neck extension position was comparable (P=0.3394). After NTS, the pressure in supine and neck extension position was comparable(P=0.7910). NTS also significantly reduced PTN in both supine (P=0.0005) and neck extension position (P=0.0005). CONCLUSIONS: NTS effectively reduced PTN of both wire-reinforced and RAE tubes regardless of supine or neck extension position. RAE tube also significantly reduced PTN compared with wire-reinforced tube.

Key words: Nasal ala, Tracheal tube, Endotracheal intubation, Pressure, Ulcer

中图分类号:

R782.05

胡文月, 吕翔, 孙宇. 鼻腔气管导管固定对经鼻气管插管患者鼻部压力的影响[J]. 中国口腔颌面外科杂志, 2021, 19(4): 345-349.

HU Wen-yue, LYU Xiang, SUN Yu. The effect of nasal tube stabilization on pressure between tube and nose[J]. China J Oral Maxillofac Surg, 2021, 19(4): 345-349.

参考文献

[1] Hall CE, Shutt LE.Nasotracheal intubation for head and neck surgery[J]. Anaesthesia, 2003, 58(3): 249-256.
[2] Huang TT, Tseng CE, Lee TM, et al.Preventing pressure sores of the nasal ala after nasotracheal tube intubation: from animal model to clinical application[J]. J Oral Maxillofac Surg, 2009, 67(3): 543-551.
[3] Singh R, Sood N, Kerai S, et al.Use of merocel^® aids in prevention of nasal pressure ulcers following nasal intubation: case series of 33 patients[J]. Indian J Anaesth, 2017, 61(6): 513-515.
[4] Edsberg LE, Black JM, Goldberg M, et al.Revised national pressure ulcer advisory panel pressure injury staging system: revised pressure injury staging system[J]. J Wound Ostomy Continence Nurs, 2016, 43(6): 585-597.
[5] Coyer FM, Stotts NA, Blackman VS.A prospective window into medical device-related pressure ulcers in intensive care[J]. Int Wound J, 2014, 11(6): 656-664.
[6] Rashvand F, Shamekhi L, Rafiei H, et al.Incidence and risk factors for medical device-related pressure ulcers: the first report in this regard in iran[J]. Int Wound J, 2020, 17(2): 436-442.
[7] Jackson D, Sarki AM, Betteridge R, et al.Medical device-related pressure ulcers: a systematic review and meta-analysis[J]. Int J Nurs Stud, 2019, 92: 109-120.
[8] Nelke KH, Pawlak W, Łuczak K.Abdominal retraction pad used in orthognathic surgery: a novel technique for nasotracheal tube stabilization during Le Fort I osteotomy[J]. J Craniofac Surg, 2016, 27(7): 1842-1844.
[9] Baek RM, Song YT.A practical method of surgical draping using the preformed RAE (Ring-Adair-Elwyn) nasotracheal tube and the mayo table in maxillofacial surgery[J]. Plast Reconstr Surg, 2003, 112(5): 1484-1485.
[10] Likitlersuang J, Leineweber MJ, Andrysek J.Evaluating and improving the performance of thin film force sensors within body and device interfaces[J]. Med Eng Phys, 2017, 48: 206-211.
[11] Komasawa N, Mihara R, Imagawa K, et al.Comparison of pressure changes by head and neck position between high-volume low-pressure and taper-shaped cuffs: a randomized controlled trial[J]. Biomed Res Int, 2015: 386080.
[12] Jin SJ, Choi YJ, Park SW, et al.Correlation between changes in thyromental distance and distance of migration of oral Ring-Adair-Elwyn tubes during neck extension with a shoulder positioner in patients undergoing neck procedures[J]. J Int Med Res, 2015, 43(3): 460-467.
[13] Liu R, Kwok YL, Li Y, et al.Objective evaluation of skin pressure distribution of graduated elastic compression stockings[J]. Dermatol Surg, 2005, 31(6): 615-624.
[14] Cordovani D, Russell T, Wee W, et al.Measurement of forces applied using a macintosh direct laryngoscope compared with a glidescope video laryngoscope in patients with predictors of difficult laryngoscopy: a randomised controlled trial[J]. Eur J Anaesthesiol, 2019, 36(3): 221-226.
[15] Barakat-Johnson M, Lai M, Wand T, et al.The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review[J]. J Wound Care, 2019, 28(8): 512-521.
[16] Siddiqui AS, Dogar SA, Lal S, et al.Airway management and postoperative length of hospital stay in patients undergoing head and neck cancer surgery[J]. J Anaesthesiol Clin Pharmacol, 2016, 32(1): 49-53.
[17] Brasileiro BF, Van Sickels JE.Nasal alar pressure ulcer after orthognathic surgery: clinical presentation and preventive recommendations[J]. J Craniofac Surg, 2019, 30(6): e533-e535.
[18] Huang WS, Chou TD, Chen TM, et al.Nasal ala pressure sores: easily missed complications of nasotracheal tube intubation[J]. J Med Sci, 2002, 22(3): 101-104.
[19] Tsukamoto M, Kobayashi M, Yokoyama T.Risk factors for pressure ulcers at the ala of nose in oral surgery[J]. Anesth Prog, 2017, 64(2): 104-105.
[20] Daniel RK, Wheatley D, Priest D.Pressure sores and paraplegia: an experimental model[J]. Ann Plast Surg, 1985, 15(1): 41-49.
[21] Hedrick-Thompson JK.A review of pressure reduction device studies[J]. J Vasc Nurs, 1992, 10(4): 3-5.

鼻腔气管导管固定对经鼻气管插管患者鼻部压力的影响

The effect of nasal tube stabilization on pressure between tube and nose

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