不同气道湿化和吸痰方法对预防急性呼吸窘迫综合征患者痰痂形成的影响

Effect of different methods of airway humidification and suction on phlegm scab formation in patients with acute respiratory distress syndrome

目的探讨急性呼吸窘迫综合征（ARDS）患者机械通气期间有效预防痰痂形成的方法。方法将96例接受机械通气的ARDS患者按单双数分为两组,单数48例为试验组,采用恒速小量持续气道湿化及密闭式吸痰方法;双数48例为对照组,采用传统间断气道湿化及开放式吸痰方法。观察两组痰液黏稠度、痰痂形成、经皮氧饱和度（SpO2）及吸痰时呛咳的情况。结果插管24h时,两组Ⅰ~Ⅲ度痰液黏稠度比较差异无统计学意义（P〉0.05）,痰痂形成比较差异有统计学意义（P〈0.01）;72h及120h时,两组Ⅰ~Ⅲ度痰液黏稠度和痰痂形成比较差异均有统计学意义（P〈0.01）。吸痰后不同时间两组患者的SpO2比较差异有统计学意义（P〈0.01）。两组湿化及吸痰中患者的反应症状比较差异有统计学意义（P〈0.01）。结论与传统间断气道湿化及开放式吸痰方法相比,采用恒速小量持续气道湿化和密闭式吸痰方法能使患者氧饱和度下降幅度小,呛咳反应轻,有效预防痰痂形成。

Objective To explore effective methods to prevent formation of phlegm scab in patients with acute respiratory distress syndrome（ARDS） during mechanical ventilation.Methods Ninty-six patients with ARDS receiving mechanical ventilation were randomly divided into two groups.The patients in the experimental group received constant small-flow airway humidification and closed endotracheal suction,while patients in the control group received intermittent airway humidification and open endotracheal suction.The viscosity of sputum,formation of phlegm scab,transcutaneous oxygen saturation and cough response during suction were compared between the two groups.Results There was no significant difference on the viscosity of sputum between the two groups at 24 hours after intubation（P0.05）,but significant differences were found on the formation of phlegm scab and oxygen saturation between the two groups at 24 hours,72 hours and 120 hours after intubation（P0.01）,as well as the viscosity of sputum at 72 hours and 120 hours after intubation（P0.01）.Significant difference was also found on the cough response during suction between the two groups（P0.01）.Conclusion Compared with traditional intermittent airway humidification and open endotracheal suction method,constant small-flow airway humidification and closed endotracheal suction method has smaller decrease of oxygen saturation and cough response,and can effectively prevent the formation of phlegm scab.