两种气管内吸引术在重型颅脑伤患者中的应用比较

目的比较开放式气管内吸引术(Open endotracheal suctioning,Open ETS)与闭合式气管内吸引术(Closed endotracheal suctioning,Closed ETS)对重型颅脑伤患者平均动脉压(MAP)、颅内压(ICP)、脑灌注压(CPP)等方面的影响及其意义。方法将32例重型颅脑伤患者随机分成Open ETS组(n=16)和Closed ETS组(n=16),于吸引前、后动态监测MAP、ICP、CPP变化。结果两组患者吸引后即时MAP均升高,Open ETS组较Closed ETS组明显(P<0.05)。吸引后即时ICP均短暂升高,两组变化趋势基本相同,大多于5min内回落。吸引后即时Open ETS组CPP下降(P<0.01),而Closed ETS组CPP变化无统计学意义。结论颅内高压状态下OpenETS可引起脑缺血、缺氧反应,而Closed ETS不损害脑灌注,并可维持足够脑氧供。因Closed ETS更具合理性,故建议颅脑外伤后可运用Closed ETS。

Application and comparison of two method for endotracheal suctioning used in severe brain trauma patients

Objective To compare the effect and importance of open endotracheal suctioning and closed endotracheal suctioning on MAP, ICP, CPP in severe brain trauma patients. Method 32 severe brain trauma patients were randomly divided into open ETS group ( n=16) and closed ETS group (n=16). The changing in MAP, ICP, CPP were continuously monitored before and after the procedure. Result MAP in both groups was increased from baseline after ETS and the increase in open ETS group was significantly more than that in closed ETS group (P<0.05). All the patients has transient elevations of ICP immediately after ETS. And there was a same trend of ICP changing in two groups. in most case, ICP had returned to baseline within 5 minutes immediately after ETS. With a concomitant decrease in CCP ( P<0.01) in open ETS group. While in closed ETS group, there was no obvious changing in CCP. Conclusion Open ETS can negatively influence cerebral oxygenation during intracranial hypertention.