不同吸痰深度对重型颅脑损伤机械通气患者颅内压力的影响

目的 研究不同吸痰深度对重型颅脑损伤机械通气患者颅内压(ICP)和呼吸机相关性肺炎(VAP)发生率的影响.方法 选取重症监护病房58例行机械通气及ICP监护的患者,分为3组,A组、B组、C组分别采取浅吸痰、改良深部吸痰、深部吸痰 3种吸痰方式,分析3组吸痰前后ICP数值变化、吸痰间隔时间和频率；分析机械通气7d内的VAP发生率.结果 A组对ICP影响最小,吸痰间隔最短,吸痰频率最高,VAP发生率60.0％.B组在吸痰瞬间ICP升高,但平均ICP高峰＜20mmHg(1 mmHg=0.133kPa),并在2min内回复基线水平,吸痰间隔较长,吸痰频率较低,VAP发生率为26.3％.C组在吸痰瞬间ICP最高,达(22.63±4.02) mmHg,需5min回复基线水平,吸痰间隔最长,吸痰频率最低,VAP发生率为21.1％.结论 针对重型颅脑损伤患者的气道管理,改良深部吸痰是一种比较安全有效的选择.

Impact of endotracheal suctioning depth on the intracranial pressure in patients with severe traumatic brain injuries receiving mechanical ventilation

Objective To investigate the impact of different endotracheal suctioning depth on the intracranial pressure(ICP) and incidence of ventilator associated pneumonia(VAP) in patients with severe traumatic brain injuries receiving mechanical ventilation.Methods Fifty-eight patients with mechanical ventilation in the neurosurgical ICU were divided into shallow suctioning group,modified deep suctioning group and deep suctioning group.The change of ICP before and after suctioning,the interval and frequency of suctioning,and the incidence of VAP within seven days during mechanical ventilation were compared.Results In shallow suctioning group,the ICP during suctioning was the most stable,but the suctioning interval was the shortest,the suctioning was the most frequent,and the incidence of VAP was 60.0 percent.In modified deep suctioning group,the ICP increased less than 20 mmHg and recovered to the baseline within two minutes after suctioning,the suctioning interval was longer,the suctioning was less frequent,and the incidence of VAP was 26.3 percent.In deep suctioning group,the ICP increased to(22.63±4.02) mmHg during suctioning and recovered to the baseline within five minutes,the suctioning interval was the longest,the frequency of suctioning was the least,and the incidence of VAP was 21.1 percent.Conclusion The modified deep endotracheal suctioning is proved to be a safer and more effective method for patients with severe traumatic brain injuries.