湿化液刺激吸痰后痰液飞溅距离与脱机成功率的关系

Relationship between Sputum Splashing Distance and Weaning Success Rate after Moisturized Liquid Stimulation and Sputum Suction

目的：观察气管切开机械通气患者湿化液刺激吸痰后痰液飞溅距离，并分析成功脱机的相关因素。方法用湿化液（3～5 mL 无菌生理盐水）湿化气道，按湿化液刺激后痰液飞溅的距离将118例气管切开机械通气患者分为4组：飞溅至管口为 A 组（n＝26），飞溅至患者管口外衣领为 B 组（n＝30），飞溅至床旁为 C 组（n＝35），飞溅至床尾为 D 组（n ＝27）。负压进管吸痰，先行脱机试验，监测最后成功脱机患者吸痰前后的 SpO2、HR、RR。结果118例患者成功脱机79例，失败39例。脱机失败：A 组18例，B 组14例，C 组6例，D 组1例。4组脱机成功率比较差异有统计学意义（χ^2＝32．406，P ＜0．05），且痰液飞溅距离与一次脱机成功率呈正相关（r＝0．518，P ＜0．05）。成功脱机患者吸痰前后的 SpO2、HR、RR 比较差异无统计学意义（P ＞0．05）。结论患者痰液飞溅的距离越远，其咳嗽反射能力越强，脱机成功率越高。痰液飞溅距离可作为预测脱机的因素之一。

Objective To observe the sputum splashing distance after moisturized liquid stimu-lation and sputum suction,and to analyze the related factors for weaning success in patients re-ceiving mechanical ventilation.Methods A total of 118 patients receiving mechanical ventilation were given moisturized liquid（3-5 mL sterile saline）for airway humidification and were divided into four groups：sputum splashing to the nozzle（group A,n=26）,to the collar（group B,n=30）, to the bedside（group C,n=35）and to the end of bed（group D,n=27）.Sputum suction was per-formed using a vacuum device.Weaning test was carried out firstly.Then,SpO2 ,heart rate（HR） and respiratory rate（RR）were measured before and after sputum suction in patients undergoing successful weaning.Results Among the 118 patients,weaning was successful in 79,and failed in 39（18 in group A,14 in group B,6 in group C and 1 in group D）.The differences in weaning suc-cess rate were significant among the four groups（χ2 =32.406,P 〈0.05）.The sputum splashing distance was positively correlated with the weaning success rate at the first attempt（r =0.518, P 〈0.05）.No obvious changes in SpO2 ,HR and RR were found before and after sputum suction in patients undergoing successful weaning.Conclusion The sputum splashing distance is positive-ly correlated with cough reflex ability and weaning success rate.Therefore,sputum splashing dis-tance can be used as a factor for predicting weaning.