【罂粟摘要】腹腔镜减肥手术期间气管插管套囊压力的变化．

腹腔镜减肥手术期间气管插管套囊压力的变化

贵州医科大学   麻醉与心脏电生理课题组

翻译 ：安丽    编辑 ：严旭    审校 ：曹莹

背景:在减肥手术，尤其是袖状胃切除术中，需要插入胃校准管(GCTs)以引流和清除胃液，并为胃体和漏气检测提供校准。置入GCT后患者咽和食管黏膜的损伤是该类插管后的主要并发症。本研究旨在观察腹腔镜减肥手术期间气管插管（ETT）套囊压力的变化，为该类手术插管后减少并发症的发生，提供一定的参考数据。

方法：这是一项前瞻性观察研究，对SAS分级I-III级病态肥胖患者（体重指数>40kg/m²）的124名患者纳入该研究。纳入研究的患者在全身麻醉下接受腹腔镜减肥手术。气管插管套囊的初始基线压力为28cmH2O，在减肥手术的各个步骤中观察气管插管套囊压力、气道峰值压力和血流动力学变化。记录术后24h内发生的并发症情况。

结果：置入GCT后气囊压力为(36.3±7.3)cmH2O，建立二氧化碳气腹后气囊压力为(33.3±3.8)cmH2O，较基线值(28cmH2O)明显升高(p<0.05)。取出GCT时气囊压力为(24.0±3.0)cmH2O，释放二氧化碳气腹时气囊压力为(24.7±3.0)cmH2O。在GCT插入后，气道压力峰值从初始基线值（25.1±3.7）cmH2O上升至（26.5±4.5）cmH2O。建立二氧化碳气腹时气道压力峰值为（32.6±4.4）cmH2O，调头低脚高体位时气道压力峰值为（32.3±4.0）cmH2O，随后恢复仰卧位后气道压力峰值为(32.5±4.8)cmH2O。

结论：在腹腔镜减肥手术中，气管插管套囊压力有显著变化，建议对套囊压力进行常规监测和调整，以尽量减少术后并发症的发生。

原始文献来源：

Dipti Saxena, Jyoti Raghuwanshi, Atul Dixit, and Subodh Chaturvedi.Endotracheal tube cuff pressure during laparoscopic bariatric surgery: highs and lows.Anesth Pain Med 2022;17:98-103.Doi:org/10.17085/apm.21044

英文原文：

Endotracheal tube cuff pressure during 

laparoscopic bariatric surgery: highs and lows

Abstract 

Background: Gastric calibration tubes (GCTs) are a unique component of bariatric surgery. This study aimed to assess changes in the endotracheal tube (ETT) cuff pressure during laparoscopic bariatric surgery. 

Methods: This was a prospective observational study consisting of 124 American Society of Anesthesiologists class I–III morbidly obese patients (body mass index > 40 kg/m2) undergoing elective laparoscopic bariatric surgery under general anesthesia. The baseline ETT cuff pressure was 28 cmH2O. Cuff pressure, peak airway pressure, and hemodynamic changes were observed during various steps of bariatric surgery. Immediate postoperative complications during the first 24 h were recorded. 

Results: ETT cuff pressure increased significantly from the baseline (28 cmH2O) after insertion of GCT (36.3 ± 7.3 cmH2O) and creation of carboperitoneum (33.3 ± 3.8 cmH2O). Cuff pressure decreased significantly on GCT removal (24.0 ± 3.0 cmH2O) and release of carboperitoneum (24.7 ± 3.0 cmH2O). Peak airway pressure increased from the initial baseline value of 25.1 ± 3.7 to 26.5 ± 4.5 after GCT insertion, creation of carboperitoneum (32.6 ±4.4), attainment of reverse Trendelenburg position (32.3 ± 4.0), and subsequent return to supine position 32.5 ± 4.8.

Conclusions: The endotracheal cuff pressure significantly varies during the intraoperative period. Routine monitoring and readjustment of cuff pressure are advisable in all laparoscopic bariatric surgeries to minimize the possibility of postoperative complications.