气流冲击结合间断声门下吸引法在降低机械通气并发症上的效果研究

目的 比较气流冲击结合间断声门吸引法、持续声门下吸引结合灌洗法在降低机械通气并发症上的效果.方法 选择行气管切开、机械通气>48 h的病人40例,按住院时间先后分为气流冲击组和灌洗组.气流冲击组采用间断声门下吸引结合每日2次气流冲击的方法清除气囊上滞留物,灌洗组采用持续声门下吸引结合每日2次声门下灌洗的方法,两组每日记录气囊上吸引量、呛咳、气道黏膜受损出血情况,并在人工气道建立1、3、7 d留取下呼吸道分泌物和声门下滞留物,进行细菌培养,比较两组病人1周气囊上吸引量、呛咳、气道黏膜受损出血及呼吸机相关性肺炎(VAP)的发生情况.结果 灌洗组与气流组病人比较中3 d VAP发生率分别为15%、5%(P>0.05)、7 d VAP发生率分别为30%、15%(P>0.05),气囊上吸引量分别为(85.30±33.50)、(84.80±35.58) mL·d-1(P>0.05),呛咳发生次数分别为(6.36±1.33)、(4.60±1.83)次(P<0.01)、气道黏膜受损出血的发生率分别为35%、5%(P<0.05).结论 气管切开病人使用气流冲击结合间断声门下吸引法较持续声门下吸引结合灌洗法,可以降低病人呛咳、气道黏膜受损出血等并发症的发生,减轻病人痛苦.

The effect of air shock combined with discontinuous glottis attract method in decreasing the complications of mechanical ventilation

Objective Comparing the effect of Air shock combined with discontinuous glottis attract method on decreasing the complications of mechanical ventilation.Method 40 patients admitted with tracheotomy and mechanical ventilation for more than 48 hours were divided into airflow shock group and lavage group.The airflow shock group receiving intermittent subglottic suction combined with the air flow two times one day to remove the retentive on the balloon and the lavage group receiving continuous subglottic suction combined with subglottic lavage 2 times one day.Recording the amount of airbag suction,cough,airway mucosal damage bleeding daily and collecting lower respiration secretion to bacterial culture in 1,3,7 d after the artificial airway were established.Result There are no difference between the two group in the incidence of VAP in 3 days and 7 days (P>0.05).The amount of suction on the balloon in the two group are considerable (P>0.05).The incidence of cough,airway mucosal damage bleeding are lower in the airflow shock group (P<0.01).Conclusion Airflow shock combined with intermittent subglottic suction method can reduce the incidence of cough,airway mucosal damage bleeding in patients with tracheostom.