纤维支气管镜吸痰结合浅部吸痰方式对ICU病房人工气道患者肺通气及肺部感染的影响

目的 通过将纤维支气管镜(FB)吸痰方式结合浅部吸痰方式进行气道管理与传统吸痰管理方式进行对比，旨在探讨对ICU人工气道患者采取不同吸痰护理方案护理效果。方法 随机抽取2017年4月至2018年12月江南大学附属医院入住ICU并建立人工气道行机械通气辅助治疗患者86例进行研究，按照吸痰护理方案不同分为2组，行FB吸痰与浅部吸痰相结合的吸痰护理管理患者为研究组，行常规吸痰护理管理患者为对照组，对建立人工气道患者第1 d、7 d动脉血气指标及呼吸力学指标进行分析，统计患者气道粘膜损伤、肺部感染情况的发生率。结果 建立人工气道第1 d两组患者P动脉血气指标及呼吸力学指标差异均无统计学意义（P>0.05）；建立人工气道第7 d研究组患者PaO2与SaO2以及PIP显著升高，PaCO2与Pplat、mPaw 、Raw显著降低，且变化范围均远优于对照组（均P<0.05）。研究组发生气道黏膜损伤与肺部感染发生率（16.27%、18.60%）均显著低于对照组（67.44%、46.51%）（均P<0.05）。结论 采用FB吸痰结合浅部吸痰护理方案对ICU人工气道患者进行干预可提升呼吸道管理质量，有效改善患者呼吸功能，减少气道黏膜损伤与肺部感染发生，具有较高的临床实践价值。

Effects of fiberoptic bronchoscopy combined with superficial suction on pulmonary ventilation and pulmonary infection in patients with artificial airways in the ICU

Objective To compare the effects of fiber bronchoscope (FB) suctioning with superficial suctioning and traditional airway management in patients with artificial airway in ICU. Methods Eight-six patients admitted to the ICU of the Affiliated Hospital of Jiangnan University from April 2017 to December 2018 were selected randomly with artificial airway assisted mechanical ventilation being established. They were divided into 2 groups according to different plans of sputum suction. The integration of FB and superficial suction was performed in research group. And the routine sputum-suction nursing manager was performed in control group. The indexes of arterial blood gas and respiratory mechanics of the artificial airway patients on day 1 and 7 were analyzed. And the incidences of injuries and lung infections were recorded. Results There was no significant difference in blood arterial blood gas index and respiratory mechanics index between the two groups of patients on the 1st day after the establishment of artificial airway(P> 0.05). However, PaO2 and SaO2 and PIP increased significantly, and PaCO2, Pplat, mPaw, and Raw decreased were significantly on the 7th day after the construction of artificial airway in study group(P<0.05). The incidences of airway mucosal injury and lung infection (16.27%, 18.60%) in the study group were significantly lower than those in the control group (67.44%, 46.51%), P<0.05. Conclusion Intervention of FB suctioning and superficial suctioning treatment in ICU patients with artificial airways can improve the quality of airway management and patients'' respiratory function effectively, which has high value of clinical practice.