肺复张操作联合震动排痰对重症监护室机械通气患者吸痰影响的临床研究

目的研究联合应用肺复张操作与震动排痰对重症监护室（ICU）内行机械通气患者的吸痰效果和相关并发症的影响及意义。方法选择建立人工气道行机械通气的ICU患者176例，随机平均分为研究组和对照组。研究组吸痰时联合应用肺复张操作与震动排痰法，对照组采用普通吸痰法。观察2组患者吸痰前后血压、心率、心律、血氧饱和度、肺功能各参数指标的变化，以及吸痰时患者症状、体征及相关并发症的发生率。结果对照组舒张压吸痰前为（78.45±1.68）mmHg，与吸痰后[（78.45±1.62）mmHg]无显著差异（P〉0.05）。研究组舒张压吸痰后为前为（70.88±1.62）mmHg，显著低于吸痰前[（75.88±1.62）mmHg，P〈0.05）]。对照组吸痰后呼吸功为（2.22±0.188）J／L，与吸痰前无显著差异[（2.22±0.178）J／L，P〉0.05]研究组呼吸功吸痰后为（1.90±0.16）J／L，显著低于吸痰前[（2.28±0.16）J／L，P〈0.05]。研究组舒张压、体表脉搏氧饱和度（SpO2）、潮气量、气道阻力、气道压力均低于对照组，而肺顺应性高于对照组（P〈0.05，P〈0.01）。研究组的吸痰次数、SpO2≥95％例数、一次吸净例数均显著多于对照组（均P〈0.05），咳嗽反应、气急、痰鸣音、蒸汽吸入、黏膜损伤例数均显著少于对照组（均P〈0.05）。结论对ICU内机械通气患者联合应用肺复张与震动排痰后吸痰法效果优于普通吸痰法。值得临床推广应用。

Effects of lung recruitment maneuver combined with vibration sputum elimination on the patients undergoing mechanical ventilation in intensive care unit

Objective To study the effects of lung recruitment maneuver combined with vibration sputum elimination on the patients undergoing mechanical ventilation in intensive care unit （ICU）. Methods 176 critically ill patients under mechanical ventilation with established artificial airway in ICU were randomly divided into 2 equal groups： study group treated with lung recruitment maneuver combined with vibration sputum suction and control group treated with routine suction. The blood pressure, heart rate , blood oxygen saturation （SpO2）, and relevant parameters of lung function before and after treatment were recorded, and the symptoms and signs while suctioning and the incidence of related complications were observed. Results The diastolic blood pressure after suction of the control group was（78.45±1.62）mmHg, not significantly different from that before suction[（78.45±1.68）mmHg, P〉0.05]. The diastolic blood pressure after suction of the study group was（70.88±1.62） mmHg, significantly lower than that before suctioning[（75.88±1.62）mmHg, P〈0.05]. The diastolic pressure,SpO2, tidal volume, airway resistance, and airway pressure were all significantly lower than those of the control group （P 〈0.05, P〈0.01）, the respiratory work of the study group was（1.90±0.16）J/L, significantly lower than that of the control group[（2.22±0.178）, P〈0.01], and the numbers of cough response, short breath, coarse rales, vapor inhalation, and mucosa damage of the study group were all significantly lower than those of the control group（all P〈0.05）. Conclusion Lung recruitment maneuver combined with vibration sputum elimination is more effective than conventional sputum elimination.