不同吸痰方式对ICU肺部感染病人吸痰效果及呼吸功能的影响

Comparative analysis of different sputum suction methods on sputum suction effect and respiratory function in patients with pulmonary infection in ICU

目的:对比2种不同吸痰方式对ICU机械通气后肺部感染病人吸痰效果及呼吸功能的影响。方法:选取ICU机械通气后肺部感染病人260例,根据不同吸痰方式分为对照组(n=115)及观察组(n=145)。对照组采用开放式吸痰,观察组采用密闭式吸痰,比较2组吸痰情况及吸痰前后1 min血气指标、呼吸功能变化。结果:观察组排痰量明显大于对照组(P<0.01),肺部啰音消失率明显高于对照组(P<0.01),吸出痰液中或吸痰管管壁有新鲜血液及吸痰时有痰液喷出率均明显低于对照组(P<0.01)。与吸痰前1 min比较,吸痰后1 min观察组血氧饱和度、动脉血氧分压均升高(P<0.05和P<0.01),动脉血二氧化碳分压降低(P<0.01);对照组血氧饱和度、动脉血氧分压均降低(P<0.05和P<0.01),动脉血二氧化碳分压升高(P<0.05)。与吸痰前1 min比较,吸痰后1 min对照组呼吸频率、吸气末呼吸道平台压、呼吸道峰压均明显增加(P<0.01),潮气量明显降低(P<0.01);观察组上述指标均无明显变化(P>0.05)。结论:密闭式吸痰可提高吸痰效果,减少或避免呼吸道黏膜损伤,改善吸痰后病人血气指标,同时不影响病人呼吸功能,吸痰效果优于开放式吸痰。

Objective: To compare the different sputum suction methods on sputum suction effect and respiratory function in patients with pulmonary infection after mechanical ventilation in ICU. Methods: Two hundred and sixty patients with pulmonary infection after mechanical ventilation in ICU were divided into the control group( n =115) and experiment group( n =145) according to the sputum suction method.The control group was treated with open sputum suction,and the experiment group was treated with closed sputum suction.The sputum suction effect,and blood gas index and respiratory function before and after 1 min of sputum suction were compared between two groups. Results: The volume of expectoration in experiment group was significantly higher than that in control group( P < 0.01 ),the disappearance rate of pulmonary rale in experiment group was significantly higher than that in control group( P <0.01),the incidence rates of the fresh blood in sputum or suction tube wall,and sputum ejection during sputum suction in experiment group were significantly lower than those in control group( P <0.01).Compared with before 1 min of sputum suction,the levels of SaO 2,PaO 2,and PaCO 2 in experiment group were increased and decreased after 1 min of sputum suction,respectively( P <0.05 and P <0.01).Compared with before 1 min of sputum suction,the levels of SaO 2,PaO 2,and PaCO 2 in control group were decreased and increased after 1 min of sputum suction,respectively( P <0.05 and P <0.01).Compared with before 1 min of sputum suction,the levels of BF,Pplat and Ppeak were significantly increased,and level of Vt significantly decreased in control group after 1 min of sputum suction( P < 0.01 ).The significant changes of the above indexes were not found in experiment group( P >0.05). Conclusions: Closed sputum suction can improve the effect of sputum suction,reduce or avoid respiratory tract mucosal damage,improve the blood gas index after sputum suction,and has no affect on the respiratory function of patients.The sputum suction effect of closed sputum suction is better than that of open sputum suction.