使用肾上腺素雾化治疗气管插管拔管后患者喉部水肿的临床研究

Clinical studies of spray treatment on adrenaline after tracheal extubation laryngeal edema

目的观察肾上腺素、布地奈德雾化吸入治疗气管插管拔管后喉部水肿的疗效。方法选取我院重症监护室于2009年1月至2013年4月行气管插管,拔管后出现喉部水肿的危重患者,共62例,治疗组予以肾上腺素雾化吸入,对照组予以布地奈德雾化吸入。观察两组患者动脉血氧分压、动脉血二氧化碳分压、心率、呼吸频率、血氧饱和度的变化,并记录经治疗后患者呼吸困难的持续时间。结果喉部水肿发作30 min后,试验组相比对照组的动脉血氧分压显著升高[(79.54±16.54)mm Hg vs.(68.71±12.62)mm Hg]、动脉血二氧化碳分压显著降低[(25.11±8.37)mm Hg vs.(34.12±6.59)mm Hg]、血氧饱和度显著升高[(93.50±5.11)%vs.(82.71±11.27)%]、相比发作时呼吸频率降低频率显著增加[(15.35±5.70)次/min vs(.9.88±6.57)次/min],差异均有统计学意义(P<0.05),心率未见明显变化;喉部水肿发作60 min后试验组动脉血二氧化碳分压显著降低[(24.24±6.41)mm Hg vs.(30.77±8.18)mm Hg],差异具有统计学意义(P<0.05),其他指标未见明显变化;试验组患者呼吸困难持续时间显著降低[(36.29±12.38)min vs.(50.91±20.47)min],差异具有统计学意义(P<0.05),症状未缓解行气管插管和气管切开人数均少于对照组。结论使用肾上腺素治疗气管插管后喉部水肿可迅速达到良好治疗效果,值得临床推广。

Objective To observe the effect of adrenaline, nebulized budesonide inhalation therapy after tracheal extubation laryngeal edema. Methods Intensive care unit of our hospital from January 2009 to April 2013 a total of 62 patients, which endotracheal intubation, laryngeal edema after extubation, treatment group were given adrenaline inhalation, control group were given budesonide aerosol inhalation. PaO2,PaCO2,SO2,RR, HR changes were observed in patients, and record the duration of dyspnea in patients after treatment. Results Laryngeal edema attacks after 30 rain, arterial oxygen partial pressure of the experimental group compared to the control group was significantly higher, a significant reduction in PaO2[ （79.54±16.54） mm Hg vs. （68.71 ±12.62） mm Hg],PaCO2[ （25.11±8.37） mmHgvs. （34.12±6.59） mmHg],SO2[ （93.50±5.11） %vs. （82.71±11.27） %] were significantly higher compared to the onset of respiratory frequency significantly reduce the frequency increases[ （ 15.35 ± 5.70） /rain vs. （9.88± 6.57） /rain], the differences were statistically significant（P〈 0.05）, HR had no significant change; laryngeal edema attacks after 60 min experimental group PaCO2 significantly reduce the differences were statistically significant [ （24.24 ± 6.41 ） mm Hg vs. （ 30.77 ± 8.18 ） mm Hg], no significant changes in other indicators. Dyspnea duration of the experimental group was significantly lower [ （36.29±12.38） min vs. （ 50.91 ± 20.47 ） min, P 〈 0.05 ], the symptoms do not ease endotracheal intubation and tracheotomy number than the control group. Conclusion The use of epinephrine treatment of tracheal intubation laryngeal edema can quickly achieve good therapeutic effect, worthy of promotion.