机械通气患者吸痰前气管内滴注生理盐水湿化的比较研究

Clinical Study on instillation of normal saline before endotracheal suction in mechanical-ventilation patients

目的探讨对已经进行湿化气道的机械通气患者吸痰时,滴注生理盐水与否对吸痰效果以及机械通气相关并发症的影响。方法选择建立人工气道机械通气30h以上患者101例,随机分成A组50例和B组51例,A组吸痰时不滴注生理盐水,B组吸痰时按传统方法常规滴注生理盐水2ml,通过观察吸痰时患者咳嗽反应、血氧饱和度、心率、血压的变化以及痰液黏稠度、呼吸机相关性肺炎(VAP)的发生率等指标进行研究。结果两组吸痰时患者心率、收缩压以及痰液黏稠度之间差异无统计学意义,B组滴入生理盐水后吸痰前心率、血压均升高,而血氧饱和度下降,与B组比较,A组吸痰时呛咳、VAP的发生率明显下降。结论吸痰时滴注生理盐水进行湿化会导致血氧饱和度下降、舒张压升高、患者刺激性咳嗽、VAP的发生率升高等不利影响,因此,机械通气吸痰不应将滴注生理盐水作为常规操作。

Objective This study aimed to describe the effects of instillation of normal saline during endotracheal suctioning, Methods 101 patients with mechanical ventilation longer than 30 hours were randomly divided into two groups, 50 as group A receiving endotracheal suction without saline instillation and 51 as group B with saline instillation at the start of endotracheal suctioning. Results There were no significant differences in terms of heart rates,systolic blood pressure and the viscosity of sputum between the two groups, while there were higher incidences of reflex cough and ventilation-associated pneumonia in group A than in group B. And in group B, after instillation of normal saline the patient＇s heart rate, blood pressure increased while SpO2 dropped compared with before. Conclusion Saline instillation during endotracheal suctioning leaded to stronger reflex cough, decreased Sp（）2 and increased incidence of VAP. So instillation of normal saline is not suggested to take during endotracheal suction,