密闭式吸痰在新生儿机械通气中的临床研究

目的：探讨在新生儿机械通气中气管内吸痰适宜方式。方法：2008年1月至2009年12月新生儿重症监护病房（NICU）机械通气的新生儿共164例,随机分为观察组和对照组,观察组86例,采用密闭式气管内吸痰,对照组78例,采用开放式气管内吸痰。观察两组在每次吸痰前、后新生儿心率、平均动脉压（MAP）、经皮测血氧饱和度（TcSO2）的变化,每天一次送检吸出痰液进行细菌培养。结果：观察组在吸痰后新生儿心率、MAP、TcSO2与吸痰前比较无明显改变,痰液细菌培养在持续机械通气24h无检出新菌株,48h检出率12.99%,3d检出率24.62%,7d检出率50.98%。而对照组在吸痰后新生儿心率、MAP与吸痰前比较明显升高,TcSO2与吸痰前比较明显降低,痰液细菌培养在持续机械通气24h检出率12.82%,48h检出率34.85%,3d检出率50.91%,7d检出率67.45%。结论：在新生儿机械通气中采用密闭式气管内吸痰更能稳定新生儿血流动力学,降低缺氧程度,缩短缺氧时间,降低院内感染,密闭式气管内吸痰更适合新生儿机械通气。

Clinical Research of Airtight Sucking Sputum in Neonatal Mechanical Ventilation

Objective：To approach the eligible modus of endotracheal sucking sputum in neonatal mechanical ventilation.Method：The 164 neonates who needed mechanical ventilation,from January 2008 to December 2009 in NICU,were divided into observation group and contrast group randomly.86 cases in observation group were used airtight endotracheal sucking sputum.78 cases in contrast group were used open endotracheal sucking sputum.To observe the change of heart rate,MAP,TcSO2 before and after sucking sputum.Bacterial culture was checked once a day.Result：In observation group,there was no conspicuous change between before and after sucking sputum in heart rate,MAP,TcSO2.New strain was not detected in bacterial culture of sputum after 24 hours’ persistent mechanical ventilation.The detection rate of 48 hours was 12.99%,and for 3 days was 24.62%,for 7 days was 50.98%.But in contrast group the heart rate and MAP were steped up obviously and the TcSO2 was steped down obviously after sucking sputum.The detection rate of bacterial culture of sputum was 12.82% after 24 hours’ persistent mechanical ventilation.The detection rate of 48 hours was 34.85%,and for 3 days was 50.91%,for 7 days was 67.45%.Conclusion：Using airtight endotracheal sucking sputum in neonatal mechanical ventilation can stabilize neonatal haemodynamics,step down hypoxia degree,decurtate hypoxia time,step down hospital onset of infection.Airtight endotracheal sucking sputum is more fit for neonatal mechanical ventilation.