吸痰方式对急性呼吸窘迫综合征呼吸力学影响的实验研究

Effect of Endotracheal Suctioning on Acute Respiratory Distress Syndrome Respiratory Mechanics: An Experimental Study

目的研究更适宜急性呼吸窘迫综合征(ARDS)机械通气犬气管内吸痰的方式。方法采用静脉注射油酸制备犬ARDS模型;每只犬随机选择使用开放式气管内吸痰(OS)和密闭式气管内吸痰(CS)2种吸痰方式。于吸痰前后记录呼吸力学监测指标的数据。结果OS和CS后,犬吸气峰压(Ppeak)、平台压(Pplat)、平均气道压力(Pmean)与吸痰前比较均明显上升(P<0.05);OS后肺动态顺应性(CD)、静态顺应性(CS)显著下降(P<0.05)。结论OS、CS均可影响气道压力;OS后降低肺顺应性。本研究提示我们,在护理工作中,应加强吸痰前后气道压力等监测;对ARDS机械通气犬吸痰时选择CS方式更适宜和安全。

Objective To find the better ways of endotracheal suctioning and caring in the ARDS mechanical ventilated dogs through animal work. Methods Tracheal intubated mongrel dogs were used to build up ARDS models by injecting oleic acid through wein. Both opened endotracheal suctioning (OS) and closed endotracheal suctioning (CS) techniques were performed on each dog in randomized order. The data of inspiratory peak pressure (Ppeak), inspiratory plateau pressure (Pplat) and mean airway pressure (Pmean) were recorded before and after suction. Results There were significant increasing in the data of Ppeak、Pplat and Pmean after suction compared to before suction in two suction ways (P< 0.05). On the contrary, the data of pulmonary static compliance (CS) and pulmonary dynamic compliance (CD) got worsen after OS compared to before OS (P< 0.05). Conclusions Both OS and CS had obvious influencing on airway pressure, and it remind us that we should intensify monitoring the changes of airway pressure during performing endotracheal suction ways in clinical nursing practice. In conclusion, we think that CS technique is comparatively safer and more comfortable for ARDS mechanical ventilated dogs.