体表定位振动排痰联合膨肺吸痰在急诊机械通气患者中的应用效果观察

Effect of vibration sputum excretion with surface location combined with lung dilated suction in patients with mechanical ventilation in emergency

目的探讨体表定位振动排痰联合膨肺吸痰在急诊机械通气患者中的应用效果。方法选择2009年6月至2013年6月北京市通州区中西医结合医院收治的急诊机械通气患者86例，按入院先后顺序随机分为观察组和对照组，每组43例。对照组采用普通吸痰方法，观察组采用体表定位振动排痰法联合膨肺吸痰法排痰，均吸痰5d。比较2组患者吸痰前、吸痰5d后动脉血氧饱和度（SaO2）、氧分压、二氧化碳分压、呼吸频率的变化；比较2组每天吸痰总量、吸痰间隔时间、吸痰彻底程度及并发症发生情况。结果吸痰前2组患者SaO2、氧分压、二氧化碳分压、呼吸频率差异无统计学意义（P〉0．05），吸痰后均较治疗前改善[对照组：（93．2±4．8）％比（87．1±6．8）％，（121±19）mmHg（1mmHg=0．133kPa）比（97±19）mmHg，（40±6）mmHg比（42±12）mmHg，（25±5）次／min比（29±7）次／min；观察组：（98．4±2．9）％比（86．7±5．8）％，（132±15）mmHg比（97±18）mmHg，（38±4）mmHg比（42±10）mmHg，（22±3）次／min比（29±7）次／min]，观察组改善程度明显大于对照组，差异均有统计学意义（均P〈0．05）。观察组第1～3天吸痰总量明显多于对照组，第4、5天吸痰总量明显低于对照组[（30．5±0．8）ml比（20．5±1．2）ml，（44．8±1．6）ml比（31．6±1．5）ml，（36．2±1．9）ml比（31．3±1．7）ml，（17．2±2．1）ml比（28．4±0．9）ml，（10．3±0．9）ml比（25．1±1．3）m1]，吸痰间隔时间明显长于对照组[（2．9±0．7）h比（1．3±1．0）h]，吸痰彻底程度明显优于对照组[（1．4±0．5）分比（2．0±0．4）分]，并发症发生率明显低于对照组[4．7％（2／43）比18．6％（8／43）]，差异均有统计学意义（均P〈0．05）。结论体表定位振动排痰联合膨肺吸痰排痰效率明显优于普通吸痰法，安全性高，对急诊机械通气患者尤其是昏迷、咳嗽乏力的患者尤为适用。

Objective To explore the effect of vibration sputum excretion with surface location combined with lung dilated suction in patients with mechanical ventilation in emergency. Methods Totally 86 patients receiving emergency mechanical ventilation from June 2009 to June 2013 were randomly divided into observation group and control group （43 cases in each group）. Control group given conventional suction sputum, observation group were given vibration sputum excretion with surface location combined with lung dilated suction. The arterial oxygen saturation （ SaO2 ）, partial pressure of oxygen （ PaO2 ）, partial pressure of carbon dioxide （ PaCO2 ）, respiratory rate （RR） before and 5 days after suction sputum were recorded ; the total amount of suction sputum, interval time of sputum suction, complete degree of suction complete degree and complications were compared between groups. Results The SaO2 , PaCO2 , PaO2 , RR were not significantly different before suction; they were significantly improved after suction in control group [ （ 93.2 ± 4.8 ） % vs （ 87.1 ± 6.8 ） %, （ 121 ± 19） mmHg vs （97±19） mmHg, （40 ＋6） mmHg vs （42 ±12） mmHg, （25 ±5） times/min vs （29 ± 7）times/mini and observation group [（98.4±2.9） % vs （86.7±5.8） %, （132±15） mmHgvs （97± 18） mmHg, （38 ±4） mmHg vs （42 ± 10） mmHg, （22 ±3） times/rain vs （29 ±7） times/mini, and were more better in observation group （P 〈 0. 05 ）. The suction amount in observation group were more on the 1 st-3rd day and were less on the 4th and 5th day compared with those in control group [ （30.5 ±0.8） ml vs （20.5 ± 1.2） ml, （44.8±1.6） mlvs （31.6±1.5） ml, （36.2±1.9） mlvs （31.3±1.7） ml, （17.2±2.1） mlvs （28.4 ± 0.9） ml, （ 10. 3 ± 0.9 ） ml vs （25.1 ± 1.3 ） ml I （ P 〈 0.05 ）. The interval time of consecutive suction sputum in observation group was significantly longer than that in control group I （ 2. 9 ± 0.7 ） h vs （ 1.3 ± 1.0 ） h 3 （ P 〈 O. 05 ）. The complete degree of suction in observation group was higher than that in control group [ （ 1.4 ± 0. 5 ） scores vs （2.0 ± 0.4） scores ] （P 〈 0.05 ）. The incidence of complication in observation group was significantly lower than that in control group [4.7% （2/43） vs 18.6% （8/43）] （P 〈 0.05）. Conclusion The effect of vibration sputum excretion with surface location combined with lung dilated suction is superior to conventional exhausting sputum method with good safety and is applicable to patients with emergency mechanical ventilation, especially for those with coma and cough asthenia.