振动排痰机治疗对呼吸机相关性肺炎患者血气分析及预后的影响

Effect of vibratory sputum ejection machine on blood gas analysis and prognosis in patients with ventilator-associated pneumonia

目的 观察振动排痰机对呼吸机相关性肺炎患者的治疗作用及对预后的影响.方法 选取2016年2月至2017年5月在本院重症监护室进行机械通气治疗并被确诊为相关性肺炎患者76例为研究对象,按照随机数表法将其分为两组,各38例.两组均进行机械通气常规吸痰处理,对照组实施氨溴索治疗,观察组在对照组基础上使用振动排痰机.比较两组治疗效果、血气指标、APACHEⅡ评分、呼吸频率、心率及预后情况.结果 观察组治疗总有效率为94.74％（36/38）,比对照组的78.95％（30/38）高,差异有统计学意义（P＜0.05）;治疗后对照组SaO2、OI、PaO2分别为（92.71±1.95）％、（331.28±16.19）mmHg、（90.05±1.57） mmHg,低于观察组的（96.92±2.58）％、（345.61±17.38） mmHg、（93.68±2.26）mmHg,PaCO2为（42.83±2.39） mmHg,高于观察组的（36.93±1.84）mmHg,差异均有统计学意义（均P＜ 0.05）;治疗后对照组APACHEⅡ评分、呼吸频率、心率分别为（14.92±3.94）分、（19.93±3.17）次/min、（81.92±4.76）次/min,均高于观察组的（10.83±3.57）分、（17.18±2.65）次/min、（75.83±5.27）次/min,差异均有统计学意义（均P＜0.05）;对照组成功脱机共24例（63.16％）,观察组成功脱机共32例（84.21％）,对照组脱机成功率比观察组低,差异有统计学意义（x2=4.343,P＜0.05）.结论 振动排痰机的使用能够有效促进呼吸机相关性肺炎患者排痰,改善血气指标及呼吸急促等情况,利于提高肺通气功能,改善预后.

Objective To observe the effcacy of vibratory sputum ejection machine in the treatment of ventilator-associated pneumonia （VAP） and its infuence on prognosis. Methods 76 VAP patients treated with mechanical ventilation at intensive care unit from February, 2016 to May, 2017 were selected and divided into two groups by random number table, 38 cases for each group. Both groups were given mechanical ventilation and routine sputum suction. The control group were treated with ambroxol, while in addition, observation group were treated wtih vibratory sputum ejection machine. The curative effects, blood gas indexes, APACHE Ⅱ I score, respiratory rate, heart rate, and prognosis were compared between the two groups. Results The total effective rate was higher in the observation group than in the control group [94.74% （36/38） vs. 78.95% （30/38）] （P〈0.05）. After the treatment, the SaO2, OI, and PaO2 were lower and the PaCO2 was higher in the control group than in the observation group [（92.71±1.95）% vs. （96.92±2.58）%, （331.28±16.19）mmHg vs. （345.61±17.38）mmHg, （90.05±1.57）mmHg vs. （93.68±2.26）mmHg, and （42.83±2.39）mmHg vs. （36.93±1.84）mmHg, all P〈0.05]. After the treatment, the APACHE Ⅱ score, respiratory rate, heart rate were （14.92±3.94）, （19.93±3.17）times/min, and （81.92±4.76）times/min in the control group and were （10.83±3.57）, （17.18±2.65）times/min, and （75.83±5.27）times/min in the observation group （all P〈0.05）. The successfully weaning rate was lower in the control group than observation group [24 cases （63.16%） vs. 32 cases （84.21%）, χ2=4.343, P〈0.05]. Conclusions Vibratory sputum ejection machine for VAP patients can effectively promote sputum excretion; improve blood gas indexes, tachypnea, and prognosis; and increase pulmonary ventilation function.