| Objective:To investigate the influence of different positions to The Low Resistance Injection method in Clinical application of endotracheal tube set of capsule filling.Methods:Totally 400 cases of elective patients who will undergoing endotracheal intubation of general anesthesia in Yan’an University Affiliated Hospital from August 2014 to December 2014.These patients who with no pathological respiratory symptoms before the operation,no smoking or drinking habits, aged at 20 to 60 years old,between 59 to 90 kg weight, ASA class all I ~ II, duration endotracheal intubation in patients within 3 hours.Included in the standard of the patients were randomly assigned to low resistance injections inflatable group(group A) and hand knead feeling sac method inflatable group(group B),Each group is divided into four groups according to different position(supine and prone position, lateral position, head low feet high).Before anesthesia to insert the endotracheal tube(ETT) according to the patients to choose the right type of endotracheal tube, two groups of gas pipe set of capsule are evenly lidocaine cream.Anesthesia induction, intravenous midazolam 0.05 mg/kg, 0.3 ug/kg sufentanil and propofol 2-2.5 mg/kg, all compounds tested alone bromine amine 0.5-1.0 mg/kg,, oral intubations under visual laryngoscope, all patients were a successful intubation.Breathing rate(RR) 10 to 12 times/min, respiratory ratio of 1:1.5, tidal volume(VT) for 8 to 10 ml/kg, minute ventilation(MV) 100-200ml/kg, oxygen concentration was 95%-97%, intraoperative adjustment at the end of the tidal volume in order to maintain a breath co2 partial pressure for about 35 to 45 mm Hg.Intraoperative monitoring electrocardiogram, blood pressure, heart rate, pulse, blood oxygen saturation and shout at the end of the carbon dioxide.Maintain anesthesia: 0.1-0.3ug/(kg.min) fentany, propofol for 3 to 5 mg/kg.(h), suitable atracurium 0.1-0.3 mg/kg.h continuous intravenous injection pump, intraoperative according to the requirements on patient’s vital signs and adjust drug pump injection speed, operation before 30 minutes to stop muscle relaxant pump injection, never put off till tomorrow what you can stop the analgesic and sedative pump injection, intravenous injection with sheen 5 mg, according to the weight and size after the conventional analgesia. Low resistance injections inflatable group A(experimental group) : after the application of low resistance injector inflatable continue to use low resistance injector to resist air valve mouth, loosen the syringe handle, make its rebound scale to stop moving after remove the syringe and dedicated the endotracheal tube air pressure gauge was used to measure the endotracheal tube air pressure value.Hand knead airbag feeling method inflatable group B(control group) : anesthesia doctors on the basis of minimum closed technology combined with their own experience to the endotracheal tube set of capsule filling, after filling in and after placing buy position with special endotracheal tube set of capsule pressure gauge to measure the endotracheal catheter capsule pressure value and after extubation airway complications,as well as the application of fiber bronchoscope examination at the time of tube drawing set of gas wall mucous membrane sac oppression.Results:1.Two groups of patients with years, height, weight, gender, endotracheal intubation time, catheter types and ASA sizing had no significant difference(p > 0.05).2. low resistance injections inflatable group(group A) at various stages in different position measurement the endotracheal tube set of capsule pressure as follows: supine position:21.95±0.69 cm H20;Proneposition T1:21.78±0.87 cm H20,T2:28.65±3.82 cm H20,T3:22.98±0.82 cm H20;Lateralposition T1:22.32±0.91 cm H20,T2:27.98±4.10 cm H20,T3:22.98±0.90 cm H20. T1 head low feet high:T1:21.88±1.00 cm H20,T2:25.43±3.21 cm H20,T3:21.78±0.70 cm H20. Hand knead airbag feeling method inflatable group(group B)at various stages in different position:supine position 35.56±10.32 cm H20, prone position t:34.56±11.01 cm H20,t2:46.669.78 cm H20,t3:35.76±7.78 cm H20,lateralposition:t1:34.86±10.23 cm H20,t2:47.32±10.23 cm H20,t3:35.38±8.34 cm H20; head low feet high: t1:35.78±11.57 cm H20,t2:39.12±8.44 cm H20, t3:34.18±6.66 cm H20. Two groups in the same position and low resistance of the injected gas measurement of the endotracheal tube set of capsule significantly lower than the hand knead set pressure value feeling method inflatable endotracheal tube set of capsule pressure value(p < 0.05), the difference was statistically significant.3. The postoperative complications, low resistance injections inflatable group(group A) incidence of postoperative complications: sore throat, cough, voice hoarse, 21%.14.5% and 9.5%.The supine complications of a sore throat, cough, voice hoarse, 18%.14% and 4%;Prone position complications of a sore throat, cough, voice hoarse, 12% and 12% 20%;The complication rate of lateral position of a sore throat, cough, voice hoarse, 28%.16% and 10%;Head low feet high incidence of complications of a sore throat, cough, voice hoarse, 18%.16% and 12%.Feel hand knead set of sac method group(group B) incidence of postoperative complications of air-filled: sore throat, cough, voice hoarse, 50.5%.33.5% and 26%.The supine complications of a sore throat, cough, voice hoarse,36%.32% and 18%;Prone position complications of a sore throat, cough, voice hoarse, 62%.32% and 28%;The complication rate of lateral position of a sore throat, cough, voice hoarse, 56%.34% and 28%.Low resistance injections inflatable group of postoperative complication rates in different positions is significantly less than the hand knead inflatable group sets of sac feeling method, complications compared the two groups was statistically significant(p < 0.05).4. Fibre bronchoscopy set of gas wall mucous membrane sac oppression, find two groups of patients with set of sac compression gas pipe wall to varying degrees of mucosa damage, low resistance injections inflatable(group A), petechiae, A total of 11 cases in each position, purpura, 4 cases of bruises was not observed;Hand knead jacketgroup(group B) capsule feeling method, petechiae, a total of 15 cases in each position, purpura in 11 cases, ecchymosis in 2 cases.Low resistance injections inflatable group(group A) set of sac compression gas pipe wall to mild damage to the mucosa(P < 0.05). The complications are still affected by different position.Conclusion:1.The anesthesiologist differences of endotracheal tube set of capsule pressure confirmation is different, the experiment showed that the operator based on their experience to the endotracheal tube jacket, sac pressure is often beyond the normal range.2. Change the body position can cause the endotracheal tube set of capsule of pressure change, even if the anesthesiologist according to the usual experience regulating the endotracheal tube set capsule pressure, also often make capsule pressure is higher than the normal range.3. The use of low resistance injections to the endotracheal tube set of capsule filling, suitable for all kinds of postures of airway management, at any time according to demand adjustment, convenient and quick, postoperative complications(sore throat, cough, hoarseness, etc.) will be significantly reduced. |
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