不同吸痰方式对重型颅脑损伤机械通气患者颅内压水平的影响

Effects of different sputum suction methods on intracranial pressure levels in patients with severe craniocerebral injury and mechanical ventilation

目的 探讨床头抬高30°时密闭式吸痰、半密闭式吸痰及开放式吸痰对重型颅脑损伤机械通气患者颅内压水平的影响.方法 采用连续入组方便取样的方法,选择首都医科大学附属北京天坛医院2016年10月—2017年12月符合纳入和排除标准的36例患者,在患者需要吸痰时依次给予密闭式吸痰、半密闭式吸痰和开放式吸痰,分别记录3种方式吸痰前、吸痰时、吸痰后2 min、吸痰后5 min、吸痰后15 min的颅内压监护仪上颅内压值,并在吸痰前及吸痰结束后15 min采集动脉血进行血气分析,记录患者的血氧分压、血二氧化碳分压.结果 3种方式吸痰时患者颅内压均升高,开放式吸痰、半密闭式吸痰和密闭式吸痰方式下患者颅内压值分别为(20.02±4.93)、(16.00±4.82)、(16.08±4.42)mmHg,差异有统计学意义(F=8.523,P<0.01);不同方式吸痰后2 min,患者颅内压值差异也有统计学意义(F=4.082,P<0.05),但其他时间点患者颅内压值比较差异无统计学意义(P>0.05).不同吸痰方式下,患者吸痰前后的血氧分压和血二氧化碳分压值比较差异无统计学意义(P>0.05).结论 床头抬高30°时,半密闭式吸痰与密闭式吸痰对重型颅脑损伤机械通气患者颅内压影响较小,且不影响吸痰效果.

Objective To explore the effects of closed sputum suction,open-closed sputum suction and open sputum suction on intracranial pressure levels in patients with severe craniocerebral injury and mechanical ventilation when the head of bed elevated by 30°.Methods Totally 36 patients who were admitted in Beijing Tiantan Hospital,Capital Medical University from October 2016 to December 2017 and conformed to the inclusion and exclusion criteria were selected consecutively by convenient sampling.The patients received closed suction(CS),open-closed suction(OCS)and closed suction(OS)as needed.The intracranial pressure(ICP)values shown on the intracranial pressure monitor were recorded at 2 min before,during and after suction as well as 5 min and 15 min after suction.Arterial blood was collected for blood gas analysis at 15 min before and after suction.The patients'partial pressure of oxygen(PaO2)and partial pressure of carbon dioxide(PaCO2)were also recorded.Results The patients intracranial pressure increased when the three different suction methods were used.ICP values for OS,OCS and CS were(20.02±4.93),(16.00±4.82)and(16.08±4.42)mmHg,respectively(F=8.523,P<0.01).There was statistical difference in ICP values at 2 min after suction between the patients received CS,OCS and OS(F=4.082,P<0.05),but there was no statistical difference in ICP values at other time points between these patients(P>0.05).There was no statistical difference in PaO2 and PaO2 values before and after suction using different methods(P>0.05).Conclusions When the head of bed is elevated by 30°,OCS and CS show small effects on ICP values in patients with severe craniocerebral injury and mechanical ventilation and do not affect the effects of sputum suction.