不同拔管方式对急性呼吸衰竭患者气管切开后的效果比较

Effects of different ways of extubation 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早拔管的方法，以减少并发症的发生，缩短病程。方法选择临沂市沂水中心医院2007年5月至2009年12月急性呼吸衰竭合并气管切开置管患者83例，2008年12月以前患者为对照组（43例），采用传统先堵管后拔管；2008年12月以后患者为观察组（40例），采用一次性拔管法，对比两组拔管方法的效果。结果观察组比对照组首次拔管时间平均提早了3．5d，观察组的血氧饱和度（SpO2）及血气分析情况、耐受程度明显优于对照组（P〈0．01），并发症发生率明显降低。结论对急性呼吸衰竭气管切开术后患者，掌握好拔管适应证，一次性拔管，配合使用蝶形透明敷料覆盖气管切开痿道，成功率高，紧急情况下也可以从瘘道重新置管，确保了患者的安全。

Objective To investigate the ways of extubation in acute respiratory failure patients treated with tracheotomy to reduce the complications and shorten the course. Methods Eighty -three acute respiratory failure in -hospital patients with tracheotomy were surveyed retrospectively from May2007 to December 2009. In our new approach the trachea cannula were pull out directlywithout obstruction in 40 cases of patients after December 2008 and the procedure of obstruction were executed before the cannula removed in 43 cases of patients before December 2008 which served as control group. Results The mean time of extubation was 3.5 days in advance compared with the control group. The SpO2 and values of blood gas analysis were more stable and the occurrences of pneumonia were lower than that of the control group and the differences were significant （P 〈 0.01 ）. Conclusions The straightforward withdrawal of trachea cannula is beneficial to the acute respiratory failure patients treated with tracheotomy, with thorough estimation of the state of illness and the cannula can be replaced from the fistulous coved with papillionace transparent dressing in some emergency situation.