聲門下分泌物抽吸與氣管黏膜傷害的關聯性

The Association of Subglottic Secretion Drainage and Tracheal Mucosa Injury

李雅婷(Yia-Ting Li) ； 王耀震(Yao-Chen Wang) ； 林孟秋(Meng-Chiu Lin) ； 劉旭崇(Hsu-Chung Liu) ； 盧敏吉(Min-Chi Lu) ； 邊苗瑛(Mauo-Ying Bien)

《呼吸治療》 11卷2期 (2012/07) Pp. 27-38

https://doi.org/10.6269/JRT.2012.11.2.03

摘要

呼吸器相關肺炎（ventilator associated pneumonia, VAP）不但會增加病患的死亡率還增加醫療資源的耗用，故預防其發生，是照護使用呼吸器病患的重要課題。多篇研究報告及醫療專業組織都建議使用附聲門下抽吸管的氣管內管，行氣囊上分泌物的抽吸，以減少微量或顯著的吸入，進而降低呼吸器相關肺炎的發生。雖然大部分的研究結果支持使用附聲門下分泌物抽吸管的氣管內管並執行此項技術，且使用後也沒有後遺症，但卻有少部分研究指出聲門下抽吸可能會導致氣管黏膜的傷害。本文以文獻回顧方式探究不同聲門下抽吸方式與氣管黏膜損傷間的關聯，發現自動連續性抽吸產生氣管黏膜損傷的機率，相對性高於間歇性抽吸法，而在不同的間歇性抽吸法中，那一種方式最能預防呼吸器相關肺炎及避免氣管黏膜傷害，至今仍未有定論。

關鍵字

呼吸器相關肺炎 ； 聲門下分泌物抽吸 ； 氣管黏膜損傷

並列摘要

Ventilator associated pneumonia (VAP) will not only increase patients' mortality rate but also accrue the consumption of medical resources. Prevention of VAP is thus an important issue in patients who are under ventilation support. Many research reports and medical societies have suggested the use of subglottic secretion drainage (SSD) endotracheal tubes. Micro or macro aspiration secretion may be minimized by performing subglottic suctioning and therefore, decrease the incidence of VAP. Although, many of the study results have supported the use of the subglottic secretion drainage technique and SSD endotracheal tubes, it is not without sequelae. Several researches have pointed out that subglottic secretion suction could induce tracheal mucosa injury. This report is to review and verify the association between subglottic secretion drainage and tracheal mucosa injury. We have learnt that the chance of tracheal mucosa injury is higher when using automatic continuous suction, than using the intermittent high pressure suction technique. The most optimal suction technique to prevent VAP while avoiding tracheal mucosa injury has not been determined.

並列關鍵字

Ventilator-associated pneumonia (VAP) ； Subglottic secretion drainage (SSD) ； Tracheal mucosa injury