高频胸壁振荡排痰系统对ICU机械通气患者排痰效果的影响

Effects of high frequency oscillatory ventilation system on sputum drainage in patients with mechanical ventilation in ICU

目的：探讨高频胸壁振荡排痰系统在ICU机械通气辅助排痰中的应用及效果。方法：选取400例ICU机械通气患者为研究对象,随机分为观察组和对照组,每组200例。对照组给予振动排痰,观察组给予高频胸壁振荡排痰。比较两组排痰量、排痰前后生命体征变化、撤机时间及呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）发生率。结果：排痰第1~5 d,观察组排痰量均显著高于对照组（P〈0.05）。排痰后,观察组心率、呼吸、收缩压及血氧饱和度分别为（87.2±10.5）次/min、（19.3±3.3）次/min、（134.4±11.2）mm Hg、（97.6±1.0）%,对照组分别为（89.3±9.6）次/min、（18.7±2.8）次/min、（135.0±14.8）mm Hg、（95.0±0.7）%,两组心率、呼吸及收缩压比较差异无统计学意义（P〉0.05）,但观察组血氧饱和度显著高于对照组（P〈0.05）。观察组撤机时间及VAP发生率分别为（6.6±2.1）d、16.0%（32/200）,对照组分别为（9.4±1.5）d、37.0%（74/200）,两组比较差异有统计学意义（P〈0.05）。结论：采用高频胸壁振荡排痰系统对ICU机械通气患者进行辅助排痰,可显著促进排痰,改善低血氧症状,缩短撤机时间,其预防VAP的效果优于振动排痰。

Objective To evaluate the application and effect of high -frequency chest well oscillation expectoration system on assistance expectoration in ICU patients with mechanical ventilation.Method 400 patients with mechanical ventilation in ICU were chose as research object,they were divided into observation group and control group,200 cases in each group.The control group was given to vibratory expectoration,and the observation group was given to high -frequency chest well oscillation expectoration sys-tem.The amount of sputum,heart rate,breathing,systolic blood pressure,blood oxygen saturation,weaning time and rate of ventilator -associated pneumonia （VAP）were compared between the two groups.Results From 1 d to 5 d,the amount of sputum in observation group significantly more than control group （P 〈0.05）.After expectoration,the heart rate,breathing,systolic blood pressure and blood oxygen saturation of observation group respectively were （87.2 ±10.5）per/min,（19.3 ±3.3）per/min, （134.4 ±11.2）mm Hg and （97.6 ±1.0）%,those of control group respectively were （89.3 ±9.6）per/min,（18.7 ±2.8）per/min,（135.0 ±14.8）mm Hg and （95.0 ±0.7）%.The heart rate,breathing and systolic blood pressure of two groups were not sta-tistical different （P 〉0.05）,but the blood oxygen saturation of observation group was significantly higher than control group （P 〈0.05）.The weaning time and rate and VAP rate of observation group respectively were （6.6 ±2.1）d and 16.0%（32 /200）,those of control group respectively were （9.4 ±1.5）d and 37.0%（74/200）.The weaning time and rate and VAP rate of observation group were significantly less than control group,the difference was statistically significant （P 〈0.05）.Conclusion Using high -frequency chest well oscillation expectoration system on assistance expectoration in ICU patients with mechanical ventilation,can promote sputum discharge,improve hypoxemia symptom,shorten weaning time,its effect of VAP prevention is better than vibratory expectoration.