急性呼吸衰竭患者气管切开术后不同拔管方式的效果比较

Comparison of Different Ways of Withdrawal End Tracheal Intubation in Acute Respiratory Failure Patients Treated with Tracheotomy

目的探讨急性呼吸衰竭患者气管切开术后拔管的最佳方法,以减少并发症的发生、缩短病程。方法选择我院2005年3月至2006年12月的43例急性呼吸衰竭合并气管切开置管患者为对照组,采用传统的先堵管后拔管方法;选择我院2006年12月至2007年12月的40例急性呼吸衰竭合并气管切开置管患者为观察组,采用一次性拔管法。比较两组拔管方法的效果。结果观察组患者总置管时间、住院时间、发生并发症的例数明显少于对照组,差异有统计学意义(P<0.01)。且观察组的耐受程度明显优于对照组,易耐受和难耐受人数比较,差异有统计学意义(P<0.01)。出现拔管指征后第1天,两组患者的SaO2、血气分析经比较,差异无统计学意义(P>0.05)。第2、3天,观察组患者的SaO2、血气分析结果与对照组比较,差异均有统计学意义(P<0.01)。结论掌握急性呼吸衰竭合并气管切开置管患者的拔管指征,采用一次性拔管,配合使用蝶形透明敷料覆盖气管切开瘘道,成功率高,且有效安全,降低了感染的发生率。

Objective To explore a new approach to withdraw endotracheal intubation cannula in acute respiratory failure patients treated with tracheotomy to reduce complications and shorten the course of disease. Methods Eighty-three patients with acute respiratory failure treated with tracheotomy were surveyed retrospectively from March,2005 to December,2007. In our new approach the trachea cannula were pulled out directly without obstruction in 43 cases after December, 2006 and the procedure of obstruction were executed before the cannula were removed in 40 cases of patients before December,2006 which served as a control group. Results The total time of withdraw endotracheal and hospitalization was shorter than that in the control group, and the cases with complication was significantly less than that in control group（ P 〈0.01）. The degree of the tolerance in the observation group was better than that in the control group（ P 〈0.01）. There was no significant difference between the two groups in the SaO2 and blood gas at the frist day after the straightforward withdrawal of trachea cannula（ P 〉0. 05）. At the second or thrid day, there was significant difference between the two groups in the SaO2 and blood gas（ P 〈0.01）. Conclusion The straightforward withdrawal of trachea cannula is beneficial to the acute respiratory failure patients treated with tracheotomy and the cannula can be removed from the fistulous tract covered with papillionace transparent dressing in some emergent situation,and can reduce the incidence of infection.