两种不同声门下吸引法在机械通气危重患者人工气道管理中的应用

Application of two different subglottic attract method in mechanical ventilation in critically ill patients with artificial airway management

目的：探讨两种不同声门下吸引法在机械通气危重患者人工气道管理中的应用效果。方法将2011年5月∽2013年5月收治的70例ICU患者随机分为实验组和对照组，每组各35例，去除各种干扰因素，观察两组患者发生VAP的例数、所占比例、发生VAP的时间、机械通气时间和ICU住院时间及两组患者每日声门下分泌物吸引量，将分泌物留取1∽2 ml做隐血试验，记录两组隐血试验的阳性率。结果实验组和对照组均能有效降低VAP的发生率，但对照组的VAP发生时间、机械通气时间、ICU住院时间优于实验组。结论两种声门下吸引方式均能有效防治VAP的发生，持续声门下吸引能保证分泌物被及时被抽吸出来，但容易导致气道黏膜的损伤出血，影响局部血供，间断声门下吸引对气道黏膜刺激较小，且能有效缩短机械通气时间和住ICU时间，在机械通气危重患者人工气道管理中使用间断声门下吸引法优于持续声门下吸引法。

Objective To explore the application effect of two different subglottic attract method in mechanical ventila-tion in critically ill patients with artificial airway management. Methods 70 patients treated in ICU from May 2011 to May 2013 were randomly divided into experimental group and control group,each group of 35 cases,remove all kinds of interference factors,the number of cases of VAP,proportion and VAP occurrence time,mechanical ventilation time and ICU length of hospital stay,and two groups of patients daily attracted subglottic secretion capacity in two groups of pa-tients were observed,discharge to return 1 to 2 ml did occult blood test,the occult blood test positive rate in both groups were recorded. Results The experimental group and control group could effectively reduce the incidence of VAP,but the VAP occurrence time,mechanical ventilation time and ICU length of hospital stay in control group were better than those of the experimental group. Conclusion Two types of subglottic attract can effectively control the occurrence of VAP,continuous subglottic attract can guarantee the secretion by timely by suction,but easy to cause the airway mucosa injury bleeding,affect the local blood supply,subglottic attract less to airway mucosa stimulation,and can effectively shorten the time of mechanical ventilation and ICU time,mechanical ventilation in critically ill patients with artificial airway management use in the discontinuous subglottic attract method is better than that of continuous subglottic attract method.