ICU机械通气患者人工气道内两种吸痰深度的效果比较

Comparative study on the effect of two types of artificial airway suction depth for ICU patients with mechanical ventilation

目的探讨ICU机械通气患者人工气道内吸痰时的有效深度。方法将在ICU行有创机械通气的34例患者随机分为浅吸痰组(吸痰管超过气管套管头端2 cm)和深吸痰组(吸痰管深入至遇阻力后上提2 cm,吸引前测量好所需深度),观察对比两组患者吸痰前后心率、血压、血氧饱和度等循环、呼吸参数的变化,以及吸痰后痰鸣音的改善情况,同时对两组气道损伤出血等不良事件发生率进行比较。结果吸痰后5 min与吸痰前1 min相比,患者心率、血压、呼吸频次的变化两组差异均无显著性意义(P>0.05);吸痰后5 min患者指脉血氧饱和度上升值、气道压力下降值及潮气量增加值深吸组高于浅吸组,组间差异有显著性意义(P<0.05);与浅吸组相比,深吸组的吸痰间隔时间较长,日吸痰次数较少,两组之间的差异有显著性意义(P<0.05);而气道黏膜损伤出血、肺部感染以及不良事件总发生率两组间差异均无显著性意义(P<0.05)。结论机械通气的危重患者人工气道内吸痰时,计算好深度后行深部吸引,有利于彻底清理呼吸道内分泌物,延长吸痰间隔时间,降低气道阻力,改善机体缺氧,并降低肺部感染的发生风险。

Objective To study the effective depth for artificial airway suction for ICU patients with mechanical ventilation. Method 34 patients with invasive mechanical ventilating were selected and divided into shallow suction group （tracheal suction tube over the first side casing 2 cm ） and depth suction group （ 2cm over tracheal protuberans, suction depth was measured before suction）. The change in circulation and respiratory parameters, such as heart rate, blood pressure and oxygen saturation was measured before and after suction between the two groups. The improving of coarse rales after suction was measured also. at the same time, the occurrence of airway injury bleeding events was compared between the two groups. Result There was no significant difference in heart rate, blood pressure and respiratory frequency I min before suction and 5 min after suction（P〉0.05）. The patients＇ oxygen saturation was increased 5min after the suction, the value of airway pressure was declined, and the tidal volume was increased in depth suction group（P〈0.05）, compared with shallow group, the interval of suction in deep suction group was longer, and frequency was less （P〈0. 05）. The occurrence of airway mucosal damage, bleeding, pulmonary infection, as well as the overall incidence were no significant difference between the two group （P〈 0.05）. Conclusion The calculation of the depth for suction was very important for mechanical ventilation in critically ill patients with artificial airway suction. It will helpful in clean-up respiratory secretions, reduce airway resistance, improve oxygen, and reduce the risk of. pulmonary infection.