早期机械通气联合气道持续负压吸引技术治疗严重肺挫伤的疗效

Effect of early mechanical ventilation with continuous vacuum suction in treatment of serious pulmonary contusion

目的 总结早期机械通气联合气道持续负压吸引技术在治疗严重肺挫伤中的临床应用价值. 方法 48例严重肺挫伤机械通气患者按随机数字表法分为机械通气＋持续负压吸引气道管理技术（持续组）20例和机械通气＋间断负压吸引气道管理技术（间断组）28例,机械通气模式采用同步间歇指令通气（SIMV）＋压力支持通气（PSV）＋呼气末正压通气（PEEP）,比较两组动脉血气、机械通气时间、相关并发症等指标的变化. 结果 通气6,24 h后,观察组与对照组PaO2分别为（100.36±5.90） mmHg、（105.34 ± 7.40） mmHg、（75.36±8.95） mmHg、（76.36±8.35） mmHg（P ＜0.01）,通气24 h后,两组氧合指数（PaO2/FiO2）分别为（283.50±15.20） mmHg、（201.50±10.20）mmHg（P ＜0.01）;两组机械通气时间及通气48 h后PEEP水平分别为（3.2±1.1）d∶（6.5±2.8）d、（4.5±2.3）cmH2O∶（8.5±2.5）cmH2O（P＜0.01）.两组相关并发症差异无统计学意义（P＞0.05）. 结论 严重肺挫伤患者早期机械通气联合气道持续负压吸引技术能持续保持呼吸道通畅,改善氧合指数,降低PEEP水平,利于较早拔管,但并不能降低呼吸机相关性肺炎及肺不张等并发症发生率.

Objective To summarize the value of early mechanical ventilation plus continuous vacuum suction in treatment of serious pulmonary contusion.Methods Forty-eight cases of severe pulmonary contusion were assigned to mechanical ventilation plus continuous vacuum suction （observation group,n =20） and mechanical ventilation plus discontinuous vacuum suction （control group,n =28）according to the random number table.Modes of mechanical ventilation were synchronized intermittent mandatory ventilation （SIMV）,pressure support ventilation （PSV）,and positive and expiratory pressure （PEEP）.Changes in blood gas analysis,mechanical ventilation time,and associated complications were compared between groups.Results At ventilation time of 6 and 24 hours,PaO2 in observation group was （100.36 ± 5.90） mmHg and （105.34 ± 7.40） mmHg respectively,with significant differences from （75.36 ± 8.95） mmHg and （76.36 ± 8.35） mmHg in control group （P 〈 0.01）.At ventilation time of 24 hours,PaO2/FiO2 was （283.50 ± 15.20） mmHg in observation group and （201.50 ± 10.20） mmHg in control group （P 〈0.01）.Mechanical ventilation time and PEEP at ventilation time of 48 hours in observation group was （3.2 ± 1.1） days and （4.5 ± 2.3） cmH2 O,with significant differences from （6.5 ± 2.8） days and （8.5 ± 2.5） cmH2O in control group （P 〈 0.01）.Associated complications of the two groups revealed no significant difference （P 〉 0.05）.Conclusion Early mechanical ventilation with sustained vacuum suction is effective to keep airway clear,improve oxygenation index,decrease PEEP level,and control the duration of mechanical ventilation,but may not lower the risks of ventilator-associated pneumonia and pulmonary atelectasis.