危重患者保留气管切开导管在有创-无创序贯机械通气中的应用价值研究

目的:探讨对常规有创-无创序贯脱机困难者,采用保留气管切开导管行无创机械通气以达到脱机目的的可行性.方法:回顾分析2006年1月至2007年12月我院中心ICU15例反复脱机困难患者.采取保留气管切开导管行无创面罩机械通气.当患者不能自主有效地清除呼吸道分泌物时,采取护理干预手段,经气切导管吸痰,以达到有效清除呼吸道分泌物的目的.结果:15例有创通气时间(36.87±21.82)d,无创通气时间最短5 d,最长38 d,平均11.5 d,全部成功脱机后逐渐拔除气切导管.脱机成功率与上年同期比较明显增高.结论:对意识欠清、对呼吸道分泌物自主廓清能力较弱、反复肺部感染致反复脱机困难的患者,采取保留气管切开导管行无创机械通气,可促进患者有效脱机,提高了脱机成功率.

Investigation of sequential invasive-noninvasive off-line with preservation of catheter for tracheotomy in patients with tracheotony

Objective: To investigate the feasibility of the getting off-line method by noninvasive mechanical ventilation while keeping the tracheotomy catheter for patients who had difficulty with conventional Sequential Invasive-Noninvasive off-line means.Methods:Data fron 15 patients with difficulty in off-line in ICU between January,2006 and December,2007 were analyzed.Once they had problems in clearing respiratory tract secretion spontaneously,aspiration of sputum through tracheotomy catheter would be applied to keep the airway unobstructed.Results:The invasive ventilation time of the 15 patients were(36.87±21.82)days.The average time of noninvasive mechanical ventilation were 11.5days,the shortest 5 days and the longest 38 days,respectively.All patients successfully got off-line.The rate of success was higher than that during the same period of 2004～2005 in comparison,when this method was not carried out. Conclusions:It is effective to apply the noninvasive mechanical ventilation while keeping the tracheotomy catheter to the patients who have difficulty in getting off-line due to unconsciousness,difficulty in clearing respiratory tract secretion spontaneously and repeated pulmonary infection,with enhanced success rate of sequential invasive-noninvasive off-line and emphasize to nurse mechanical ventilation.