COPD患者行机械通气时吸痰深度的探讨

Study on Depth of Suction of Endotracheal Tubes in Ventilated Patients with COPD

目的探讨慢性阻塞性肺部疾病（COPD）患者行机械通气期间最佳吸痰深度。方法对入住ICU的61例COPD合并急性肺部感染、呼吸衰竭的机械通气患者随机分为两组，一组为对照组（吸引管插入深度不超过气管导管或气管切开套管的头端），另一组为实验组（吸引管穿过气管导管，至有阻力感时后退1-2cm ），观察吸痰前后患者心率、血压、心律、指测血氧饱和度及气道阻力的变化情况。结果两组患者吸痰前和吸痰后5min的心率、血压、心律、指测血氧饱和度的差值显示差异无显著性；吸痰后20min气道阻力的下降值，实验组（-19．62±7．91）明显大于对照组（-13．64±5．27），差异有显著性（P〈0．05）。结论对于机械通气初期，分泌物较多的呼吸衰竭患者宜深部吸痰，可以减少吸痰频次，缓解气道阻力，有效改善缺氧时间。

Objective To find the optimal depth of suction of endotracheal tubes. Methods Sixty-one ventilated patients with COPD in ICU were divided into 2 groups： the control group （catheter passed to length of endotracheal tubes only） and the experimental group （ catheter passed beyond the tip of the endotracheal tubes,backed off 1 - 2 cm when it met resistance ）. The patients＇ heart rate, blood pressure, rhythm of heart,SaO2 and change of resistance were recorded respectively before and after suction. Results The patients＇ heart rate, blood pressure, rhythm of heart and SaO2 had no significant difference before and 5 minutes after suction. But at 20 minutes after suction, the decrease of the airway resistance in the experimental group（ - 19.62 ± 7.91 ） was significantly more than that in the control group （ - 13.64 ± 5.27 ） （ P 〈 0. 05 ）. Conclusion To the patients who had more secretion during the early stage with endotracheal tubes,deep suction of endotracheal tubes could reduce the frequency of suction and time of hypoxemia.