不同吸痰方法在重型颅脑损伤机械通气患者中的应用研究

Study on the application of different sputum suction methods in mechanical ventilation patients with severe traumatic brain injury

目的比较密闭式吸痰法与开放式吸痰法在重型颅脑损伤行机械通气患者中的应用效果。方法严格按照纳入标准,选择2015年2月—2017年11月亳州市人民医院重症医学科救治的60名重型颅脑损伤行机械通气的患者,根据入院先后顺序进行相应的编号,然后按照随机数字表法划分成2组,观察组28名,对照组32名,观察组及对照组分别利用密闭式吸痰法及开放式吸痰法,观察并记录2组患者在吸痰前后脉搏氧饱和度(SPO2)及心率(HR)的波动幅度,1周内呼吸机相关性肺炎(VAP)的发生例数,呼吸机使用时间,28 d内死亡人数。结果2组患者年龄分布、性别比例、昏迷严重程度(格拉斯评分)、入院24 h内急性生理健康评分(APACHEⅡ评分)最差值等一般资料基线指标比较,差异无统计学意义(P>0.05)。两种方法吸痰后,2组患者的SPO2均有下降,心率均会增加,但观察组患者的氧饱和度及心率波动幅度更小,2组相比差异均有统计学意义(P<0.05);2组患者1周内VAP发生的例数、呼吸机使用的时间、28 d内死亡的人数进行对比,差异均无统计学意义(P>0.05)。结论条件允许时,建议对重型颅脑损伤患者使用密闭式吸痰法,因为此法在吸痰前后氧饱和度及心率的波动幅度更小,可能更有利于重型颅脑损伤患者的预后,值得推广。

Objective To compare the effect of closed sputum suction method and open sputum suction method in patients with severe traumatic brain injury with mechanical ventilation. Methods Strictly according to the standard of admission, 60 patients in the intensive care unit of the Bozhou People＇ s Hospital with severe traumatic brain injury treated by mechanical ventilation from February, 2015 to November, 2017 were selected and numbered according to the order of admission, and randomly divided into observation group with 28 cases and control group with 32 cases, using closed sputum suction method and open sputum suction method respectively in the two groups. The amplitude of pulse oxygen saturation （ SPO2 ） and heart rate （HR） before and after phlegm suction, number of cases of ventilator-associated pneumonia （VAP） within 1 week, duration of ventilator use, and number of deaths within 28 days were observed and recorded in the two groups. Results There was no significant difference in age distribution, male/female ratio, coma severity （Glass score）, and the maximum difference of acute physiological health score （APACHE Ⅱ score） in 24 h between the two groups （P 〉 0.05）. SPO2 decreased and heart rate increased after both methods of phlegm aspiration, but the range of oxygen saturation and heart rate fluctuation was smaller in the observation group （ P 〈 0.05 ）. There was no statistical significance in the number of cases of VAP within 1 week, the time spent on ventilators, and the number of deaths within 28 days （ P 〉 0.05 ）. Conclusion When the conditions permit, it is recommended to use the closed phlegm suction method for patients with severe craniocerebral injury, because the oxygen saturation and heart rate fluctuated less before and after phlegm. Application of this method may be more conducive to the prognosis of patients with severe craniocerebral injury, and is worthy of promotion.