异丙肾上腺素雾化吸入在机械通气患儿拔管后的应用与护理效果

Application and effect of aerosol inhalation of isoprenaline on neonates with mechan-ical ventilation after air tube drawing

目的：观察雾化吸入异丙肾上腺素在机械通气患儿拔管后减轻气道反应与喉头组织水肿、改善呼吸困难方面的效果。方法90例行气管插管机械通气患儿随机分为观察组与对照组，每组45例，对照组拔管后在吸氧、抗感染基础上，予盐酸氨溴索（30 mg）、地塞米松（5 mg）氧气驱动雾化吸入，观察组在此基础上添加异丙肾上腺素（0.25 mg）雾化吸入，观察拔管后呼吸与局部症状改善状况。结果观察组患儿吸气三凹征改善时间（1.3±0.3）d、喉头水肿消退（2.1±0.6）d与痰液消失时间（2.9±0.6）d及面罩吸氧时间（4.2±0.9）d均短于对照组（1.9±0.4、2.8±0.5、3.7±0.5、5.1±1.2）d；撤机成功率（95.6%）高于对照组（82.2%），且差异具有统计学意义（ P〈0.05）；观察组患儿气道损伤比例（2.2%）低于对照组（13.3%），差异具有统计学意义（ P〈0.05）；雾化吸入异丙肾上腺素组患儿未见明显血压波动与心率不齐等不良反应。结论异丙肾上腺素联合盐酸氨溴索、地塞米松氧气驱动雾化吸入能显著减轻拔管后患儿喉头水肿，改善通气功能，提高撤机成功率；同时避免反复吸痰导致的气道损伤，减少护理工作。

Objective To explore the effect of aerosol inhalation of isoprenaline on neonates with mechanical ventilation after air tube drawing. Methods Ninety neonates with mechanical ventilation were randomized into observa-tion group and control groups, each group comprised 45 cases respectively. After air tube drawing, in the control group, all the patients were treated with oxygen inhalation and anti-infection treatment, aerosol inhalation of ambroxol （30 mg） and dexamethasone （5 mg） , based on the control group, observation group was added isoprenaline （0. 25 mg） during in-halation each time, the improvement of breathing and local symptoms were observed. Results （1） Three-concave sign relieving time, laryngeal edema disappearing time and sputum vanishing time in the observation group ﹝ （1. 3±0. 3） d, （2. 1±0. 6） d, （2. 9±0. 6） d, （4. 2±0. 9） d respectively﹞ were all less than those in the control group ﹝ （1. 9±0. 4） d, （2. 8±0. 5） d, （3. 7±0. 5） d, （5. 1±1. 2） d respectively﹞;success rate of removing mechanical ventilator in observational group （ 96. 7%） was higher than that in the control group. （ 2 ） Airway injury rate in observation group （2. 2%） was less than the control group （13. 3%） . （3） BP elevation and reflecting HR dropping were rarely seen in observational group. Conclusions Aerosol inhalation of isoprenaline allied with ambroxol ＆amp; dexamethasone can obviously alleviate laryngeal edema and improve respiratory function, and increase success rate of removing rate of me-chanical ventilator;meanwhile, facilitate nursing works.