全麻术后综合干预ICU患者肺不张的临床效果探讨

Study on Clinical Effect of General Intervention in the Atelectasis of ICU Patients after the General Anesthesia

目的探讨全麻术后予综合性干预措施预防肺不张的发生,其主要措施包括动态调节机械通气参数联合膨肺、浅镇静方法;通过比较预防组及对照组肺不张发生率,了解综合干预措施的临床效果。方法选取2014年1月—2017年3月对全麻术后存在肺不张高危因素(全麻药残留、平卧位、高龄、限制性肺功能手术、腹胀等)且最后转入ICU共239例患者的临床资料为研究对象,年龄18~60岁之间,随机分为预防组(121例)和对照组(118例),通过积极治疗后了解预防组(121例)及对照组(118例)肺不张发生率、平均住院日的比较。结果预防组肺不张发生率13.22%,对照组肺不张发生率30.51%,明显优于对照组,差异有统计学意义(P<0.01);预防组(121例)平均通气天数为(6.00±2.10)d,对照组(118例)为(8.00±3.40)d,预防组较对照组平均住院天数缩短,差异有统计学意义(t=5.49,P<0.01)。结论积极、综合干预措施对全麻术后存在肺不张高危因素患者预防肺不张效果明显,降低了肺不张发生率,缩短了患者ICU住院时间,值得临床上推广及应用。

Objective To study the clinical effect of general intervention measures such as dynamic adjustment of mechanical ventilation parameters combined with manual hyperinflation and light sedation method in atelectasis of ICU patients after the general anesthesia and know the clinical effect by comparing the incidence rate of atelectasis in the prevention group and control group.Methods 239 cases of patients with atelectasis high-risk factors after the general anesthesia from January 2014 to March 2017(general anesthesia residual,horizontal position,old age,restrictive pulmonary function surgery and abdominal distension)and transformed to ICU finally were selected as the research objects and the age was between 18 and 60 years old,and the patients were randomly divided into the prevention group with 121 cases and the control group with 118 cases,and the incidence rate of atelecasis and average length of stay after the positive treatment were compared.Results The incidence rate of atelectasis in the prevention group was obviously better than that in the control group(13.22%vs 30.51%),and the difference was statistically significant(P<0.01),and the average ventilation day in the prevention group and in the control group was respectively(6.00±2.10)d and(8.00±3.40)d,and the average length of stay in the prevention group was shortened compared with that in the control group,and the difference was statistically significant(t=5.49,P<0.01).Conclusion The effect of positive and general intervention measures in preventing the atelectasis of patients with high-risk factors is obvious,which can reduce the incidence rate of atelectasis and shorten the ICU length of stay of patients,and it is worth promotion and application.