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目的探讨气囊漏气试验(CLT)在悬雍垂腭咽成形术(UPPP)术后患者的拔管中的应用。方法选择2015年7月至2016年12月南京医科大学附属江宁医院的UPPP术后均带经口气管插管返回重症监护病房患者80例,其中男性53例,女性27例,年龄32~54岁。将患者随机分为2组,CLT评估拔管组(观察组)40例,经验性评估拔管组(对照组)40例。观察组男性28例,女性12例,年龄(44.4±10.2)岁;对照组男性25例,女性15例,年龄(46.8±9.4)岁。术后给予常规治疗,患者通过拔除气管插管初步筛查后,对照组观察舌体和咽后壁肿胀消退、上呼吸道通畅,即可决定拔管;观察组做CLT,当漏气量≥130 m L为CLT阴性,随即予以拔管。记录两组急性生理学及慢性健康状况评分系统(APACHE)Ⅱ评分,比较两组患者术后带管时间、拔管后上气道梗阻例数、拔管后再插管例数。结果两组APACHEⅡ评分比较,差异均无统计学意义[观察组(13.8±4.8)分vs对照组(12.1±6.4)分;P>0.05]。观察组患者术后带管时间明显缩短于对照组[(1.4±0.4)d vs(1.9±0.2)d],差异有统计学意义(P<0.05);拔管后观察组出现上气道梗阻1例,对照组出现上气道梗阻6例;两组比较,差异有统计学意义(P<0.05);但两组患者拔管后再插管率差异无统计学意义(P>0.05)。结论 CLT作为一种无创性的方法,操作简单易行,而且能够较为准确地预测UPPP术后患者拔管后气道通畅度,值得临床推广。
Objective To investigate the application of balloon air leak test (CLT) in extubation of postoperative patients with uvulopalatopharyngoplasty (UPPP). Methods From July 2015 to December 2016, 80 patients who returned to the ICU through oral intubation after UPPP in Jiangning Hospital affiliated to Nanjing Medical University were enrolled, including 53 males and 27 females, aged 32-54 years . The patients were randomly divided into two groups, CLT assessment extubation group (observation group) 40 cases, empiric evaluation extubation group (control group) 40 cases. The observation group consisted of 28 males and 12 females, with an average age of 44.4 ± 10.2 years. In the control group, 25 males and 15 females were aged 46.8 ± 9.4 years. Postoperative conventional treatment, the patient by initial removal of endotracheal intubation screening, the control group observed tongue and pharyngeal wall swelling subsided, upper respiratory tract patency, you can decide to extubation; observation group to do CLT, when the amount of air leakage ≥ 130 m L is CLT negative, then extubation. Two groups of acute physiology and chronic health status score system (APACHE) scoring system were recorded. The postoperative time of tube insertion, the number of upper airway obstruction after extubation and the number of intubation after extubation were compared. Results There was no significant difference in APACHEⅡscore between the two groups (13.8 ± 4.8 in the observation group vs 12.1 ± 6.4 in the control group; P> 0.05). The duration of laparotomy in the observation group was significantly shorter than that in the control group [(1.4 ± 0.4) d vs (1.9 ± 0.2) d], with significant difference (P <0.05). The upper airway obstruction 1 case, the control group appeared on the airway obstruction in 6 cases; the two groups, the difference was statistically significant (P <0.05); but the two groups after extubation intubation rate was no significant difference (P> 0.05). Conclusions As a noninvasive method, CLT is simple and easy to operate, and it can predict the airway patency after extubation of patients with UPPP more accurately and is worthy of clinical promotion.