气道廓清技术在重型颅脑损伤昏迷患者肺康复中的应用

Application of airway clearance technology in pulmonary rehabilitation of coma patients with severe craniocerebral injury

目的:探讨气道廓清技术在重型颅脑损伤昏迷患者肺康复中的应用价值。方法:将68例重型颅脑损伤昏迷患者随机数字表法分为观察组和对照组各34例。对照组给予常规抢救治疗及护理,观察组在常规抢救治疗基础上辅以气道廓清技术排痰。观察2组患者治疗前、治疗后第3天,第7天,第14天的动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2)),第14天时格拉斯哥昏迷评分(GCS)、采用超声检测膈肌厚度分数(DTF)、成功撤离呼吸机和转普通病房的患者比率、发生呼吸机相关性性肺炎(VAP)情况。结果:治疗后第3、7及14天时与治疗前比较2组患者PaO_(2)、PaO_(2)/FiO_(2)均呈逐渐升高趋势(均P<0.05),PaCO_(2)均呈逐渐降低趋势(均P<0.05),且观察组各时间点PaO_(2)、PaO_(2)/FiO_(2)升高和PaCO_(2)降低较对照组明显(均P<0.05)。观察组患者第14天时GCS评分、DTF和成功撤离呼吸机、转普通病房的患者比率明显高于对照组(均P<0.05),而发生VAP比率明显少于对照组(P<0.05)。结论:重型颅脑损伤患者早期辅以气道廓清技术帮助排出气道分泌物,能有效改善氧供、改善膈肌功能、降低呼吸机相关性性肺炎的发生,提高早期撤机率,缩短患者在重症病房住院时间,值得临床进一步推广应用。

Objective:To explore the application value of airway clearance technology in lung rehabilitation in coma patients with severe craniocerebral injury.Methods:A total of 68 coma patients with severe craniocerebral injury who were admitted to Intensive Care Unit(ICU)and Neurosurgical ICU of Ordos Central Hospital from March 2020 to September 2021 were selected.Patients were equally divided into observation group and control group according to the random number table.The control group was given conventional rescue treatment and nursing,and the observation group was supplemented with airway clearance technology for sputum extraction,twice a day,30 to 40 min each time,for 14 days.Arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and oxygenation index(PaO_(2)/FiO_(2))were observed before treatment,on the 3rd,7th and 14th day after treatment in 2 groups.At 14th day,Glasgow Coma score(GCS)was recorded,diaphragm thickness score(DTF)measured by ultrasound,and proportion of patients successfully evacuated from the ventilator,transferred to a general ward and occurrence of ventilator-associated pneumonia(VAP)within 14 days were analyzed.Results:After treatment,PaO_(2) and PaO_(2)/FiO_(2) in 2 groups continued to increase on the 3rd,7th and 14th day compared with those before treatment,while PaCO_(2) continued to decrease.The PaO_(2) and PaO_(2)/FiO_(2) in observation group increased significantly on the 3rd,7th and 14th day as compared with those in control group,while PaCO_(2) decreased significantly.The differences were statistically significant(all P<0.05).The GCS score,DTF,proportion of patients successfully evacuated from the ventilator and transferred to a general ward in observation group were significantly higher than those in control group.The incidence rate of VAP was significantly lower in observation group than that incontrol group,with statistical significance(P<0.05).Conclusion:In patients with severe craniocerebral injury,airway clearance technology can effectively improve oxygen supply,diaphragmatic function,reduce the occurrence of ventilator-associated pneumonia,improve the probability of early evacuation and shorten the length of stay in the ICU,which is worthy of further clinical application.