不同吸痰负压对重型颅脑损伤患者颅内压的影响

Effects of different sputum suction pressure on intracranial pressure of severe craniocerebral injury patients

目的探索最佳的重型颅脑损伤患者的吸痰负压标准,以求在达到最好的吸痰效果同时,维持较为稳定的颅内压。方法便利抽样法选取南京大学医学院附属鼓楼医院神经外科2019年1—12月收治的重型颅脑损伤的患者120例。按照随机数字表法将患者分为4个不同的吸痰负压组:75 mmHg(1 mmHg=0.133 kPa)组、100 mmHg组、150 mmHg组、200 mmHg组,每组30例。观察并比较4组患者吸痰前1 min、吸痰中和吸痰后1 min颅内压和SpO_(2)水平,以及痰液吸净时间及黏膜损伤情况。结果吸痰中4组间比较:200 mmHg组颅内压为(22.23±4.80)mmHg,均高于75 mmHg组的(16.33±2.71)mmHg、100 mmHg组的(17.70±2.32)mmHg、150 mmHg组的(17.20±2.11)mmHg(q=8.29、6.58、7.23),SpO_(2)为0.906±0.048,均低于其他3组的0.956±0.013、0.946±0.018、0.952±0.023(q=7.81、6.08、6.69),差异有统计学意义(均P<0.01)。吸痰后1 min 4组间比较,颅内压(F=10.55)和SpO_(2)(F=36.57)差异有统计学意义(均P<0.01),其中200 mmHg组颅内压最高为(15.63±3.64)mmHg,100 mmHg组为(12.50±1.48)mmHg、150 mmHg组为(12.60±1.00)mmHg,均比75 mmHg组的(14.03±2.86)mmHg低。痰液吸净时间比较,75 mmHg组最长为(35.53±5.71)s,200 mmHg组最短为(24.27±3.22)s,4组比较差异有统计学意义(F=47.81,P<0.01)。气道黏膜损伤发生率比较,200 mmHg组为33.33%(10/30),比其他3组发生率高,差异有统计学意义(χ^(2)=15.41,P<0.01)。结论对于重型颅脑损伤人工气道痰液黏稠度Ⅰ~Ⅱ度患者,使用100~150 mmHg吸引负压,能更好地保持颅内压的稳定,同时控制SpO_(2)下降幅度和防止气道黏膜受损。

Objective To explore the best negative pressure standard of sputum aspiration in patients with severe craniocerebral injury,so as to achieve the best sputum aspiration effect and maintain relatively stable intracranial pressure.Methods Totally 120 patients with severe craniocerebral injury admitted to the Department of Neurosurgery of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January to December 2019 were selected by convenience sampling method.According to the random number table method,patients were divided into 4 different negative pressure sputum aspiration groups:75 mmHg(1 mmHg=0.133 kPa)group,100 mmHg group,150 mmHg group,200 mmHg group,with 30 patients in each group.The levels of intracranial pressure and SpO_(2),sputum cleaning time and mucosal injury were observed and compared in 4 groups:1 min before sputum aspiration,1 min after sputum aspiration and during sputum aspiration.Results Comparison of intracranial pressure and SpO_(2) in sputum aspiration among the four groups:intracranial pressure in 200 mmHg group was(22.23±4.80)mmHg,which was higher than 75 mmHg group(16.33±2.71)mmHg,100 mmHg group(17.70±2.32)mmHg,150 mmHg group(17.20±2.11)mmHg(q=8.29,6.58,7.23),and SpO_(2) was 0.906±0.048,which was lower than 0.956±0.013,0.946±0.018,0.952±0.023 in the other three groups(q=7.81,6.08,6.69),with statistical significance(all P<0.01).There were statistically significant differences in intracranial pressure(F=10.55)and SpO_(2)(F=36.57)among the four groups 1 min after sputum aspiration(P<0.01);the 200 mmHg group had the highest intracranial pressure(15.63±3.64)mmHg;the 100 mmHg group was(12.50±1.48)mmHg and 150 mmHg group was(12.60±1.00)mmHg,which had lower intracranial pressure than the 75 mmHg group(14.03±2.86)mmHg.The sputum cleaning time was(35.53±5.71)s in 75 mmHg group which was the longest and the shortest in 200 mmHg group(24.27±3.22)s,with statistical significance among the four groups(F=47.81,P<0.01).The incidence of airway mucosal injury in 200 mmHg group was 33.33%(10/30),which was higher than that in the other three groups,and the difference was statistically significant(χ^(2)=15.41,P<0.01).Conclusions For patients with severe craniocerebral injury,artificial airway sputum viscosityⅠ-Ⅱdegree,suction negative pressure of 100-150 mmHg can better maintain the stability of intracranial pressure,control the decline of SpO_(2) and prevent the damage of airway mucosa,and effectively reduce the adverse effects of sputum aspiration on patients with severe craniocerebral injury.