摘要目的:探讨机械通气危重患者气管插管持续气囊压监测下有效压力范围，以达到既能保证通气质量又能减少黏膜损伤，且不增加气管导管移位及误吸发生率的目标。方法:选择2017年6月至2019年6月于天津医科大学总医院空港医院急创中心重症监护病房（ICU）住院的非肺部疾病气管插管机械通气危重患者90例，并按随机数字表法分为3组，每组30例。所有患者均采取床头抬头30°的卧位；持续测囊压法保证3组气囊压力分别维持在20、25、30 cmH 2O（1 cmH 2O＝0.098 kPa）。每小时记录1次患者平静时的呼吸机漏气量、血氧饱和度、有无气管导管移位；于拔除气管导管时使用纤维支气管镜吸痰，查看有无黏膜损伤；行胸部X线检查肺部感染情况并进行痰细菌培养检查。 结果:3组患者性别、年龄、病情危重情况差异均无统计学意义。囊压30 cmH 2O组气道黏膜损伤患者明显多于20 cmH 2O组（例：8比4， P<0.05）；而囊压20 cmH 2O组与囊压25 cmH 2O组间、囊压25 cmH 2O组与囊压30 cmH 2O组间气道黏膜损伤情况差异无统计学意义。气囊压在20、25、30 cmH 2O时，气囊漏气（例：14、10、12）、气管导管移位（例：18、11、16）、呼吸机相关性肺炎（例：3、4、3）发生情况差异均无统计学意义（均 P>0.05），且患者机械通气时间和住院时间差异也无统计学意义〔机械通气时间（h）：77.07±65.34、80.80±70.20、77.60±65.23，ICU住院时间（d）：5.70±3.74、5.30±4.57、6.23±3.51，均 P>0.05〕。 结论:在低囊压（20 cmH 2O）下不会增加患者机械通气时间和住院时间，且低囊压在气道黏膜损伤方面更加安全。

abstractsObjective:To explore the effective pressure range under continuous cuff pressure monitoring in critical patients with mechanical ventilation, so as to achieve the goal of ensuring ventilation quality and reducing mucosal injury without increasing the incidence of endotracheal catheter displacement and aspiration.Methods:Ninety critically ill patients with non-pulmonary diseases admitted to the department of intensive care unit (ICU) of Airport Hospital of Tianjin Medical University from June 2017 to June 2019 were enrolled, and divided into three groups according to the random number table, with 30 patients in each group. For all patients in the three groups , the head of the bed was raised by 30°and the balloon was measured continuously. Cuff pressure in the three groups were maintained at 20, 25 and 30 cmH 2O (1 cmH 2O = 0.098 kPa) respectively. The patient's air leakage, oxygen saturation, tracheal tube displacement of each group were recorded every hour when the patients were calm. Fiberbronchoscope was used to aspirate sputum during extubation to check for mucosal damage. Chest X-ray examination was used to evaluate pulmonary infection and sputum bacteria culture examination was conducted at the same time. Results:There was no significant difference in gender, age and critical condition among the three groups. The number of patients with airway mucosal injury in the 30 cmH 2O group was significantly higher than that in the 20 cmH 2O group (cases: 8 vs. 4, P < 0.05). There was no significant difference in airway mucosal injury between Group 20 cmH 2O and Group 25, Group 25 cmH 2O and Group 30 cmH 2O. When the balloon pressure was 20, 25, and 30 cmH 2O, there was no significant difference in air bag leakage (cases: 14, 10, 12), trachea catheter displacement (cases: 18, 11, 16), ventilator-associated pneumonia (cases: 3, 4, 3), all P > 0.05, and there was no significant difference in mechanical ventilation time and the hospitalization time [mechanical ventilation time (hours): 77.07±65.34, 80.80±70.20, 77.60±65.23; the length of ICU stay (days): 5.70±3.74, 5.30±4.57, 6.23±3.51, all P > 0.05]. Conclusion:The cuff pressure of 20 cmH 2O will not increase the mechanical ventilation time and hospitalization time of patients, while 20 cmH 2O is much safer in airway mucosal injury.