不同吸痰方式对急性呼吸窘迫综合征患者肺换气功能的影响

Effects of different endotracheal suction techniques on ventilation of patients with acute respiratory distress syndrome

目的 研究不同吸痰方式对急性呼吸窘迫综合征(ARDS)机械通气患者肺换气功能的影响,选择更安全和有效的气管内吸痰方式,减少吸痰对肺气体交换的影响,提高吸痰操作的安全性。方法 在外科重症监护病房选取诊断ARDS并行机械通气治疗的患者,每例患者均使用开放式气管内吸痰(OS)和密闭式气管内吸痰(CS)两种方式进行吸痰,吸痰顺序随机选择,观察记录患者在不同吸痰方式下,吸痰前后各个时间段的血气分析值和脉搏血氧饱和度(SpO2)的变化。结果 OS后患者动脉血氧分压、动脉血氧饱和度、SpO2 比吸痰前显著降低(P<0.05),OS加重了ARDS患者低氧血症;而CS前后上述指标比较差异无显著性意义(P>0.05)。结论 CS对ARDS患者肺换气功能影响较小,ARDS患者行机械通气治疗时气管内吸痰选择CS方式更为安全和适宜。

Objective The objective of this study is to assess changes of ventilation function of the patients with ARDS as open endotracheal suction (OS) and closed endotracheal suction (CS) were used, and to find a better method for the patients. Methods 14 patients with ARDS and assisted mechanical ventilation in Surgical Intensive Care Unit(SICU) were enrolled. Both OS and CS suction techniques were performed on each patient in randomized order. The data of blood gas were obtained at 2 min before suction and 30 sec after suction. The data of oxygen saturation by pulse oximetry (SpO 2) were collected during the procedure of suction. Results Significant differentiation was found for the data of arterial oxygen partial pressure (PaO 2), arterial oxygenation (SaO 2) and SpO 2 between before and after OS ( P <0.05). The results showed a decrease in the data after OS.There were not statistical differences between before and after CS.Conclusions It was found that CS technique did not worsen the function of ventilation, compared with OS.CS technique is comparatively safe and comfortable for ARDS patients.