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題名 | The Role of the Cuff Leak Test in Predicting the Effects of Corticosteroid Treatment on Postextubation Stridor=氣囊漏氣測試在使用類固醇治療拔管後哮鳴的角色 |
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作者 | 王智亮; 蔡熒煌; 黃崇旂; 吳耀光; 葉明珠; 周秀憫; 徐士宭; 林孟志; Wang, Chih-liang; Tsai, Ying-huang; Huang, Chung-chi; Wu, Yau-kwang; Ye, Ming-zhu; Chou, Hsiu-min; Shu, Shih-chun; Lin, Meng-chih; |
期刊 | 長庚醫學 |
出版日期 | 20070100、20070200 |
卷期 | 30:1 2007.01-02[民96.01-02] |
頁次 | 頁53-61 |
分類號 | 415.4 |
語文 | eng |
關鍵詞 | 拔管後哮鳴; 咽喉水腫; 氣管插管; 皮質性類固醇; 拔管失敗; 氣囊漏氣試驗; Postextubation stridor; Laryngeal edema; Endotracheal intubation; Corticosteroid; Extubation failure; Cuff leak test; |
中文摘要 | 背景:氣管內插管會造成喉頭不同程度的損傷及腫脹,導致日後拔管發生哮鳴。此為拔管失敗的一個重要原因。目前研究顯示,拔管前預防性使用類固醇並不能減少哮鳴發生,而且也沒有有關拔管後發生哮鳴的標準治療方法。氣囊漏氣試驗是一個簡單、非侵犯性測試,其能間接反映出咽喉部位腫脹的程度。我們假設類固醇可以減輕喉部局部發炎腫脹,對拔管後發生哮鳴的病患施予類固醇治療,並使用氣囊漏氣試驗來驗證類固醇的療效。 方法:我們進行一項前瞻性研究,針對110位內科加護病房插管病患,統計拔管後發生哮鳴機率及危險因子,並使用類固醇治療拔管後哮鳴。利用氣囊漏氣試驗來追蹤拔管後發生哮鳴的病人在接受類固醇治療前後,呼吸器漏氣量的變化來監測咽喉水腫改善的程度。 結果:有20個病人發生哮鳴(18.2 %),經類固醇治療後有9人哮鳴逐漸改善。11個需再次插管的病患中,有7人經類固醇治療後成功拔管不再發生哮鳴。整體而言,類固醇對拔管後發生哮鳴的治療成功率為80%;對因哮鳴而再次呼吸衰竭的治癒率也達64%。氣囊漏氣試驗顯示在類固醇治療後,呼吸器漏氣量在統計學上有顯著增加(治療後152.4±109.6 ml vs. 治療前29.9±35.7 ml, p=0.012)。女性和低漏氣量(本實驗的閾值為88 ml;陽性預測率為54.5%,陰性預測率為90.9%)為拔管後發生哮鳴的高危險因子。插管時間長短、有無插管病史及血液白蛋白數值高低與拔管後哮鳴發生無關。 結論:類固醇能治療因插管引起的喉頭水腫所造成的拔管後哮鳴。氣囊漏氣試驗可以用來預測拔管後哮鳴是否發生,並能監測類固醇治療喉頭腫脹的療效。 |
英文摘要 | Background: There is not enough evidence to determine the most appropriate treatment of postextubation stridor. Although the cuff leak test is a simple method to predict postextubation stridor, little is known about its use in monitoring the effects of steroid treatment for this complication. The aim of this study was to evaluate the effect of steroids on postextubation stridor based on the clinical response and the cuff leak test. Methods: A cohort of 110 translaryngeal intubated patients in the medical intensive care unit (ICU) were enrolled. A cuff leak test was conducted before extubation. Patients developing postextubation stridor were intravenously given 5 mgs of dexamethasone every 8 hours for 3 days. The clinical response and cuff leak volume before and after steroid treatment were gathered for analysis. Results: The incidence of postextubation stridor was 18.2% (20/110). Fifty-five percent of patients (11/20) with stridor needed reintubation. Overall, 80% of patients (16/20) with postextubation stridor improved with steroid treatment. The leak volume significantly increased after treatment (152.4 ± 109.6 ml vs. 29.9 ± 35.7 ml, p = 0.012); stridor did not recur in 64% of reintubated patients (7/11). A threshold leak volume of less than 88 ml predicted the occurrence of stridor (positive predictive value, 54.5%; negative predictive value, 90.9%). Postextubation stridor was associated with the female gender and lower leak volumes (p = 0.007 and 0.003, respectively). Conclusion: Corticosteroids improve postextubation stridor. The cuff leak test accurately predicts the absence of stridor and is a non-invasive method of monitoring for regression of laryngeal edema after steroid treatment. Steroid treatment should be considered for patients developing postextubation stridor. |
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