两种呼吸机接头在机械通气患者吸痰中的应用效果

Effectiveness Evaluation of Two Kinds of Ventilator Connect Tap for the Sputum Suction in Patients with Mechanical Ventilation

目的探讨两种呼吸机接头在机械通气患者吸痰中的应用效果。方法便利抽样法选择2012年1-12月上海第二军医大学长征医院急诊监护室(emergency intensive care unit,EICU)收治的经气管插管并进行机械通气>12d的患者42例为研究对象,按照患者的入院先后将其分为对照组和观察组各21例,其中每组神志清醒患者各10例,12d为1个观察周期。对照组患者采用呼吸机直管接头将人工呼吸道与呼吸机连接,观察组患者采用呼吸机直管接头加延长弯管(即呼吸机延长管)将人工呼吸道与呼吸机连接。比较两组患者呼吸机相关性肺炎、咳嗽反射、清醒患者恐惧感的发生率。结果两组患者肺部感染率的差异有统计学意义(χ2=9.050,P<0.01)。两组患者吸痰时的咳嗽反射、痰液喷出、痰痂堵塞发生率的差异有统计学意义(P<0.05)。两组各有10例神志清醒的患者,其吸痰恐惧的差异亦有统计学意义(χ2=5.639,P<0.01)。对照组患者每次吸痰平均操作时间为(128.03±23.6)s,长于观察组的(85.66±10.23)s,差异有统计学意义(t=3.564,P<0.05)。结论使用呼吸机延长管的机械通气患者,其呼吸机相关性肺炎发生率低、恐惧感低、吸痰操作时间缩短,对患者的呼吸、心率、血压及动脉血氧饱和度等影响小、缺氧程度低,另外还可减少脱管的发生,值得临床推广使用。

Objective To discuss the application effect of two kinds of ventilator connect tap in patients with mechanical ventilation for the sputum suction.Methods By convenience sampling,42 patients were randomly selected from January 2012 to December 2012 in emergency intensive care unit （EICU）of Shang-hai Changzheng hospital who received endotracheal intubation and mechanical ventilation for more than 12 days.According to the patients admission time,patients were equally divided into control group and experi-mental group.Patients in control group were using ventilator connect tap of straight pipe while those who in the experimental group were using ventilator connect tap of straight pipe and an extend bend tube （ex-tension ventilor connect tap）.The incidence of ventilator associated pneumonia,cough reflex,lucid patients fear were compare between two groups of patients.Results There were statistic significance of pneumonia between two groups of patients （χ2 =9.050,P 〈0.01）.There were statistical significances of cough reflex, sputum overflowing,sputum suction phlegm scabs jams between two groups （P 〈 0.05 ）.There were 10 conscious patients in both groups,and the difference of their sputum suction fear was statistically signifi-cant （χ2 = 5.639,P 〈0.01 ）.The average sputum suction operation time in control group were（128.03 ± 23.6）s,which was significantly longer than in experimental group of （85.66±10.23）s （t =3.564,P 〈0.05）. Conclusion Use breathing machine extension tube of the low incidence of ventilator associated pneumonia in patients with mechanical ventilation,less of fear,sputum suction operation time shortened,the patient＇s breathing,heart rate,blood pressure and arterial blood oxygen saturation effect was small,low degree of hypoxia,in addition,still can reduce the incidence of pipe dropping,and it is worthy of clinical use.