摘要:目的:評價II代引流型喉管(LTS II)和Proseal喉罩(PLMA)在擇期手術中應用效果。方法:檢索了Cochrane圖書館(2009年第3期)、Pubmed(1950～2009)、EMBase(1989～2009)、CNKI(1979～2009)、VIP(1989～2009)、CBM(1978～2009)中相關II代引流型喉管(LTS II)和Proseal喉罩在擇期手術中應用的隨機對照試驗(RCT),同時篩檢納入文獻的參考文獻。由2名研究者對文獻質量進行嚴格評價和資料提取,根據指標相應異質性進行描述性分析或Meta分析(RevMan 5.0)。結果:共納入3個RCT,共244例研究對象,文獻質量均為B級。3個RCT的結果顯示與PLMA相比,LTS II具有相似的首次置入成功率(P=0.45)、術畢即刻上呼吸道損傷發生率(P=1.00)、術后24 h咽痛發生率(P=0.81)、術后24 h吞咽困難發生率(P=0.12)。2個RCT的結果顯示兩組引流管置入均較容易。1個RCT的結果顯示兩組的操作者主觀評價相近(OR=1.86,95%CI 0.39～ 8.99)。氣道封閉效果由于采用方法學差異性較大,指標也不盡相同,尚不能得出準確結果。結論:LTS II在擇期手術中用于氣道管理具有較好的前景。但是現時仍不宜用于需在擇期術中進行控制通氣的病人。關于氣道封閉效果,尚需采用更合理規范的指標、更高質量的研究設計進一步研究。Abstract: Objective: To assess the efficacy of laryngeal tube suction II (LTS II) and LMAProseal (PLMA) for airway management in elective surgery. Methods:We searched Cochrane Library (2009),Pubmed (19502009)、EMBase (19892009),CNKI (19792009),VIP (19892009),CBM (19782009). The quality of the trials was assessed by two reviewers independently. RevMan 5.0 software provided by the Cochrane Collaboration was used for statistical analysis. Results:Three studies involving 244 participants were included. Same rates of fist successful attempt (P=0.45),upper airway trauma (P=1.00),sore throat (P=0.81) and dysphagia (P=0.12) were observed in LTS II and PLMA in all studies. Two studies indicated that the insertion of gastric tube was easy in both groups. The similarity of subjective maneuverability in two groups was reported in one study (OR=1.86, 95%CI 0.39 to 8.99). The correct result of effectiveness of airway seal could not be made because of various methods and measurements. Conclusion:LTS II have a good perspective in the airway management. Otherwise, it is not safe for patient required control ventilation because of lack of evidence on the effectiveness of airway seal. More RCTs of high quality need to be undertaken in the future.
ObjectiveTo summarize the experiences of artificial airway management for inhalation injury patients undergoing tracheotomy. MethodsA retrospective analysis was made on the clinical data of 16 patients with inhalation injury who accepted artificial airway implantation after tracheotomy from January 2012 to October 2014. Certain measures were taken for the patients such as timely sputum suction in a correct way, effective airway moist, timely airway lavage, strict aseptic operation, reasonable position management, dynamic observation and health education. ResultsFifteen patients were cured, and one died. Among the cured patients, there were one case of catheter change due to blocked sputum, and one case of catheter outward portion sliding depth adjusting. ConclusionStrengthening artificial airway management after tracheotomy is the key to keep airway unobstructed, to prevent complications, and to guarantee the safety and a speedy recovery of patients.
0bjective To compare the effect of closed airway management system and open suction system on distribution and drug susceptibility of pathogenic bacteria in lower respiratory tract of mechanical ventilated patients.Methods Fifty-nine cases in ICU who received mechanical ventilation for more than 48 h from May 2006 to Dec 2006 were randomly divided into two groups.Group A(29 patients)received closed—tracheal suction and Group B(30 patients)received open-tracheal suction.Quantitative bacteriological culture and sensitivity of antibacterial drugs were conducted on lower respiratory tract secretion samples.Results In group A，a total of 91 strains were isolated，in which a single pathogen infection(41.4％)was the most frequent，followed by mixed infection of two pathogens(34.5％)and three or more pathogens(24.1％).In group B，a total of 141 strains were isolated，in which three or more pathogen infection(53.33％)was the most frequent，followed by two pathogen infection(30％)and a single pathogen infection(16.7％ ).Pathogen distribution between the two groups was not significantly different(Pgt;0.05).Drug susceptibility test did not show significant difference in main pathogens between the two groups(Pgt;0.05).Conclusions Closed airway management system can reduce the infection or colonization of mixed pathogens，but can not change the distribution and drug susceptibility of pathogens.