不同黏稠度分泌物持续声门下吸引负压值的选择

Study on different suction pressures based on secretion viscosity for optimal evacuation of subglottic secretion

目的探讨持续声门下负压对不同黏稠度分泌物的吸引效果,旨在为临床患者提供安全有效的吸引负压。方法对行机械通气使用可冲洗式气管导管或套管的33例患者,按照声门下分泌物黏稠度分级标准分为Ⅰ～Ⅲ度,Ⅰ～Ⅲ度组将患者随机排序,依次采用-2.66～0kPa及以下、-5.32～-2.79kPa、-7.98～-5.45kPa、-10.64～-8.11kPa的压力吸引声门下分泌物。观察不同黏稠度分泌物在各压力吸引下分泌物残留、呛咳发生、黏膜损伤、血氧饱和度变化、残留分泌物吸净时间情况。结果Ⅰ、Ⅱ度分泌物在不同压力声门吸引,分泌物吸净时间、残留率、呛咳发生率、黏膜损伤率比较,差异有统计学意义(均P<0.01)。Ⅲ度分泌物在不同压力声门下吸引,分泌物残留率、吸净时间、呛咳发生率比较,差异有统计学意义(均P<0.01)。结论使用-5.32～-2.79kPa压力对Ⅰ度分泌物吸引,在避免黏膜损伤的同时,达到吸引的最大化。使用-7.98～-5.45kPa压力对Ⅱ度、Ⅲ度分泌物吸引,在保持吸引有效性的同时,保证气道黏膜的安全。

Objective To explore the influence of suction pressures based on secretion viscosity on evacuation of subglottic secretions, and to find out safe and effective suction pressure for clinical practice. Methods Totally, 33 patients intubated with a Hi-Lo Evac en- dotracheal tube were enrolled. Everyday we evaluated the subglottic secretion viscosity and selected 4 different suction pressures （-2.66-0 kPa, -5.32--2.79 kPa, -7.98--5.45 kPa, and -10.64--8.11 kPa） to remove secretion for every viscosity level （grade Ⅰ-Ⅲ ）. The incidence of secretion residual, cough,and mucosal injury, the change of oxygen saturation,and the time to clear secretion residual under different suction pressures for every viscosity level of secretion were compared. Results The time to clear secretion residual, incidence rates of secretion residual, cough, and mucosal injury, under four kinds of suction pressures for grade Ⅰ and Ⅱ secretion had significant differences （P〈0.01 for all）. Incidence rates of secretion residual, and cough, and the time to clear secretion residual under four kinds of suction pressures for grade Ⅲ secretion had significant differences （P〈0.01 for all）. Conclusion Suction pressure of -5.32-- 2.79 kPa yields optimal evacuation of grade I subglottic secretion and avoids mu cosal injury. Suction pressure of -7.98-- 5.45 kPa produces effective evacuation of grade Ⅱ or Ⅲ secretion.