密闭式低压快速吸痰法在急性呼吸窘迫综合征行高PEEP治疗中的应用及效果

Application and effect of closed low pressure rapid sputum suction for acute respiratory distress syndrome patients treated with high PEEP

目的探讨密闭式低压快速吸痰法在急性呼吸窘迫综合征(Acute Respiratory Distress Syndrome,ARDS)行高呼气末正压通气(positive end expiratory pressure,PEEP)治疗中的应用效果。方法选取2017年1月~12月在我院行ARDS机械通气治疗的患者60例,根据患者入院单双日,将患者分为对照组和干预组,每组30例,其中对照组患者采用传统的硅胶吸痰管进行开放式吸痰(open endotrachseal suctionging,OS),干预组患者采用密闭式吸痰(closed endotracheal suctionging,CS),主要采取密闭式吸痰、低负压吸痰和减少吸痰时间三种措施联合应用。观察比较两组患者吸痰前1min和吸痰后3min的心率、平均动脉压等血流动力学指标以及动脉血氧饱和度(SaO2)、脉搏氧饱和度(SpO2)等动脉血气指标变化情况,并统计记录两组患者吸痰操作时间、费用以及吸痰后的气道损伤、呼吸机相关性肺炎(VAP)、院内感染发生率等方面的差异。结果两组患者吸痰前1min心率、平均动脉压、血氧饱和度等指标及吸痰后的气道损伤、VAP、院内感染发生率,比较均无显著性差异(P>0.05);吸痰后3min干预组患者的心率、平均动脉压、血氧饱和度等指标均优于对照组,吸痰操作时间(21.10±5.37)min、费用(57.44±8.38)元,显著少于对照组(52.50±8.43)min和(94.65±11.56)元,且P<0.05。结论在ARDS患者行高PEEP时,使用密闭式低压快速吸痰法能保障患者的气道通畅,维持患者血流动力学稳定,不会增加VAP等并发症发生率,且能降低护理人员的工作时间和成本,是一种安全有效、综合效果显著的吸痰方式,值得在临床推广应用。

Objective To investigate the effect of closed low pressure rapid sputum aspiration in treatment of acute respiratory distress syndrome (ARDS) patients received positive end expiratory pressure (PEEP).Methods 60 patients with ARDS mechanical ventilation in our hospital from January 2017 to December were randomly divided into the control group and the intervention group,with 30 cases in each group.The control group was treated with open endotrachseal suctionging (OS) by traditional silica gel suction tube,and the intervention group was given closed endotracheal suctionging (CS) combined with closed type sputum absorption,low negative pressure phlegm absorption and reducing sputum absorption time.The changes of blood gas parameters such as heart rate,respiratory frequency,arterial oxygen saturation (SaO2 ) and pulse oxygen saturation (SpO2) were observed and compared between the two groups before phlegm suctioning and sputum absorption,and the time and cost of sputum aspiration in the two groups was recorded as well as the airway injury and ventilator correlation after sputum absorption.The differences in the incidence of pneumonia (VAP) and nosocomial infection were compared between the two groups.Results There was no significant difference in heart rate,mean arterial pressure,blood oxygen saturation and the incidence of airway injury,VAP and nosocomial infection between the two groups 1-minute before sputum suction ( P> 0.05).3 minutes after sputum suction,the heart rate,mean arterial pressure and oxygen saturation of the intervention group were better than those of the control group.The operating time of sputum suction was (21.10 ±5.37) min and the cost was (57.44±8.38) yuan,which were significantly lower than the control group (52.50±8.43) min and (94.65±11.56) yuan ( P< 0.05). Conclusion Closed low pressure rapid sputum aspiration can guarantee their airway patency,maintain hemodynamic stability,and reduce the working time and cost of nursing staff,and do not increase the incidence of complications such as VAP in treatment of ARDS patients received PEEP,which is a safe,effective and comprehensive method of sputum absorption and worthy of widely clinical application.