机械通气患者撤机拔出气管插管序贯性护理的临床效果研究

Clinical effectiveness study on artificial airway sequential mechanical ventilation patients withdraw machine pull out

目的：探讨机械通气患者自主呼吸试验（SBT）成功，撤离呼吸机顺利拔出气管插管后给予主动气道加温湿化序贯性护理的临床新方法及新技术。方法纳入2013年1月至2014年5月武警后勤学院附属医院呼吸与重症医学科建立气管插管实施机械通气成功撤机拔出气管插管患者135例，采用随机数字表法将研究对象随机分为A、B 2组，A组68例，B组67例；A组采用浮标式吸氧装置，B组采用主动气道加温湿化治疗装置。测量2组患者拔出气管插管后72 h呼吸频率、PaO2、SpO2、心率、临床肺部感染评分（CPIS）；采用气道分泌物评分评价在拔出气管插管前、拔出气管插管后24、48、72 h痰液黏稠度。结果2组患者在性别、年龄、临床诊断、机械通气时间、急性生理与慢性健康评分系统Ⅱ评分等方面差异无统计学意义（P＞0.05）；B组患者拔出气管插管后72 h呼吸频率、心率和CPIS分别为（20.94±0.89）、（80.79±4.67）次/min和（7.13±2.54）分，A组分别为（24.12±0.97）、（86.32±5.12）次/min和（8.79±3.56）分，2组比较差异有统计学意义（t=5.113、7.298、5.597，均P＜0.01）；B组PaO2、SpO2分别为（93.24±1.96）mmHg（1 mmHg=0.133 kPa）、0.9732±0.0148，A组分别为（87.35±2.32）mmHg、0.9378±0.0132，2组比较差异有统计学意义（t=9.279、4.548，均P＜0.01）；拔出气管插管前2组痰液黏稠度比较差异无统计学意义（P＞0.05），拔出气管插管后24、48、72 h，B组患者痰液黏稠度较A组适宜（Z=-2.684、-2.870、-2.771，均P＜0.01）。结论机械通气患者撤机成功拔出气管插管后采用浮标式吸氧装置不利于痰液引流，改善患者呼吸困难及低氧血症不明显；采用主动气道加温湿化序贯性护理有利于纠正低氧血症，可改善患者呼吸功能，减少呼吸困难症状；降低痰液黏稠度，促进气道引流通.，缩短肺部感染时间。

Objective On patients with mechanical ventilation spontaneous breathing trial (SBT) success, out of breath machine smoothly pulled out after endotracheal intubation for active airway moist sequential therapy of clinical new method and new technology. Methods Between January 2013 and May 2014 respiratory endotracheal intubation implementation of mechanical ventilation with intensive medicine successful withdraw machine pulled out of 135 patients with tracheal intubation, they were divided into group A(68 cases) and group B(67 cases) by random digits table method. The patients in group A were treated with buoy type oxygen device, group B with active airway moist heat treatment unit. The breathing rate, PaO2, SpO2, heart rate, Clinical Pulmonary Infection Score(CPIS) were measured after 72 h&nbsp;of pull out endotracheal intubation in two groups. Sputum viscosity was evaluated by Airway Secretions Score before pull out endotracheal intubation and after 24, 48, 72 h of pull out endotracheal intubation in two groups. Results There were no significant differences between two groups in gender, age, clinical diagnosis, mechanical ventilation time, acute physiology and chronic health evaluation systemⅡrating etc (P>0.05). The breathing rate, heart rate and CPIS score respectively (20.94 ± 0.89), (80.79±4.67) times/min and (7.13 ± 2.54) points after 72 h of pull out endotracheal intubation in group B, and (24.12 ± 0.97), (86.32 ± 5.12) times/min and (8.79±3.56) points in group A, and there were significant differences(t=5.113, 7.298, 5.597, all P<0.01). PaO2, SpO2 were (93.24±1.96) mmHg(1 mmHg=0.133 kPa), 0.973 2±0.014 8 in group B, and (87.35±2.32) mmHg, 0.937 8±0.013 2 in group A, and there were significant differences(t=9.279, 4.548, all P<0.01). There was no significant difference in sputum viscosity before pull out endotracheal intubation between two groups (P>0.05). After 24, 48 and 72 h of pull out endotracheal intubation, group B of patients with sputum viscosity was suitable in group A (Z=-2.684,-2.870,-2.771, all P < 0.01). Conclusions Mechanical ventilation in patients with ventilator buoy type oxygen device for the pull out after endotracheal intubation success does not favor the sputum drainage, improve patients with dyspnea and hypoxemia is not obvious. By positive airway plus temperature humidity to sequential therapy is helpful to correct hypoxemia, improve the patients' respiratory function, reduce the breathing difficulties, reduce sputum viscosity, promote the airway drainage unblocked, shortening the time of lung infection.