封闭式吸痰在先天性心脏病术后机械通气患儿中的应用

The Assessment of applying closed endotracheal suction system on postoperative cardiac patients

目的 观察封闭式吸痰对体外循环心脏手术后患儿呼吸机相关性肺炎的发生率、住院费用以及对生命体征的影响.方法 选择2012年1月至2013年12月304例体外循环心脏手术后需机械通气的患儿,采用配对队列研究方法,按投掷硬币法随机分为观察组和对照组,每组152例,观察组使用封闭式吸痰管,对照组使用开放式吸痰管.比较两组患儿吸痰时心率、血压和血氧饱和度（SpO2）的变化,每次吸痰操作时间,呼吸机相关性肺炎发生率,机械通气时间,住院费用等情况.结果 两组患儿基础疾病一致,吸痰后30 s时,观察组患儿的心率和血压变化均低于对照组（P＜0.05）,吸痰后30 s和60 s观察组SpO2均高于对照组（P＜0.05）.两组意外脱管和气胸等并发症发生率差异无统计学意义.观察组相比于对照组,每次吸痰操作时间短[（156±6）s对（225 ±8）s,t=-84.86,P＜0.01],呼吸机相关性肺炎发生率低（12.0％对18.6％,x2=4.37,P＜0.05）,机械通气时间短[（72±33）h对（98 ±38）h,t=-6.35,P＜0.05],经人工气道吸痰费用高[（346±15）元对（178±26）元,=69.00,P＜0.01],但住院总费用低[（32011 ±2 525）元对（35 264±3 846）元,t=-8.72,P＜0.05].两组患儿死亡比例差异无统计学意义（x2=0.08,P＞0.05）.结论 封闭式吸痰对体外循环手术后患儿生命体征影响较小,可以减少交叉感染和吸痰的相关并发症,缩短患儿术后机械通气期间和住院时间,降低住院费用,可考虑在心胸外科重症监护病房推广使用.

Objective To investigate the effect on incidence of ventilator associated pneumonia（VAP）,the cost of hospitalization with closed endotracheal suctioning and vital sign as well in postoperative cardiac patients.Methods 304 postoperative cardiac patients supporting by ventilation were enrolled in this cohort study during January,2012-November,2013 in The Second affiliated Hospital＆ Yuying Children Hospital of Wenzhou Medical University.All the subjects were randomly divided into observational group and control group by coin side.Closed endotracheal suctioning system was applied in observation group and opened mode was applied in control group.Compare the vital sign（heart rate,blood pressure,saturation） at the moment of aspiration,suction time,incidence of VAP,duration of ventilation,mortality,the cost of suction,hospital stays and hospitalization expense.Results The baseline is no significant difference between two groups.The fluctuation of blood pressure and heart rate is lower in observational group at 30 second since completed the suction（P ＜0.05）,but saturation is higher at 30 second and 60 second since completed the suction respectively（P ＜ 0.05）.There is no significant difference of incidence of unexpected tube displacement and pneumothorax between two groups.Average time of each suction of experimental groups is shorter than Control groups[（156 ± 6） s vs （225 ± 8） s,t =-84.86,P ＜ 0.01].VAP incidence is lower in experimental group （12.0％ vs.18.6％,x2 =4.37,P ＜ 0.05）.Duration of ventilation is lower in experimental group[（72 ± 33） h vs.（98 ± 38） h,t =-6.35,P ＜ 0.05].The cost of suction is higher in observational group [（346 ± 15） RMB vs.（178 ± 26） RMB,t =69.00,P ＜ 0.01],but the hospitalization expense is lower in experimental group [（32 011 ± 2 525） yuan vs.（35 264 ± 3 846）yuan,t =-8.72,P ＜ 0.05].There is no significant difference in mortality between two groups （x2 =0.08,P ＞ 0.05）.Conclusion Application of closed endotracheal suction system can result in reduction vital sign fluctuation and incidence of cross infection and reducing the workload of nurses and decreasing the complication of suction,shorting the duration of ventilation and hospitalization and saving the expense of hospitalization in postoperative cardiac patients comparing with open mode.It is worthy to be populized in cardiac care unit.