吸痰对呼吸衰竭时机械通气患儿呼吸力学的影响

目的　 监测呼吸衰竭行气管插管和用呼吸机患儿在痰液雍塞和吸痰后呼吸力学变化及保持呼吸道通畅的措施。方法 　对因呼吸衰竭行机械通气的患儿吸痰前及吸痰后 2 0min时 ,监测呼吸频率 (RR) ,呼出潮气量 (VTEXP) ,气管导管周围漏气率 (Leak % ) ,呼吸系统动态顺应性 (CDYN) ,平均气道阻力 (Rawmean)等呼吸力学参数。 结果 　对 11例患儿进行了 5 2例监测 ,吸痰前、后气道阻力分别为 (116 73± 2 7 12 )cmH2 O/L .s和 (93 38± 2 6 6 4)cmH2 O/L .s,两者比较有显著差异P <0 0 1;吸痰前、后气管导管周围漏气率分别为 (18 12± 4 12 ) % ,(8 71± 3 76 ) % ,两者比较差异有显著性P <0 0 5 ;吸痰后呼出潮气量 (7 31± 2 12 )ml/kg较吸痰前 (5 72± 1 2 )ml/kg明显升高 ,P <0 0 1,吸痰后呼吸频率明显降低。 结论 　痰液雍塞时气道的呼吸力学将发生明显变化 ,及时采取措施、彻底清除痰液 ,保持呼吸道通畅 ,在呼吸衰竭治疗中至关重要。

The respiratory mechanics assessment of intraendotracheal tube suctioning in ventilated children

Objective　To evaluate the effectiveness of intratracheal tube suctioning by respiratory mechanics measurement.Methods　The indexes of respiratory mechanics,including respiratory rate,expiratory tidal volume,% leak around the tube,dynamic respiratory compliance and mean airway resistance were measured just before and 20 minutes after intraendotracheal tube suction in mechanical ventilated children with respiratory failure.Results　Fifty-two measurements was carried out in 11 patie nts.The mean values of respiratory risistance was (116.73±27.12)cmH2O/L.s before suctioning and (93.38±26.64)cmH2O/L.s after suctioning,with significant differrence(P＜0.01)；The mean values of % leak around the tacheal tube dereased from(18.12±4.12)% before suctioning to (8.71±3.76)% after suctioning (P＜0.05),The mean values of expiratory tidal valume was markedly increased from(7.31±2.12)ml/kg before suctioning to(5.72±1.2)ml/kg after suctioning(P＜0.01),The total respiraory rate markedly decreased after suctioning.Conclusion　The respiratory mechanics measurement is very useful to evaluate the airway patient.The removal of secretions is crucial in respiratory managemet.