改良早期更换气囊漏气的气管切开套管对患者的影响

目的:研究采用改良方法早期更换气囊漏气的气管切开套管对患者的影响。方法:随机将72例早期气囊漏气的气管切开患者分为常规换管组(A组)和改良早期换管组(B组),B组采用无气囊气管导管作为支架在发现气管切开套管漏气时即予更换,观察一次性换管成功率、换管时间、漏气期间与换管后3d内平均每天发生气促次数、发现气囊漏气时及发现漏气后5d取痰行细菌培养并行床边胸部X线拍片以了解肺部感染情况、漏气期间及换管后均抽取动脉血气分析、气囊漏后的机械通气时间及发现气囊漏气后ICU停留时间等指标。结果:改良早期更换组一次性换管成功率高于常规组(P<0.05),换管时间亦短于常规组、换管期间SpO2下降发生率低于常规组、局部出血少于常规组(均P<0.05)。换管后肺部细菌感染发生率、漏气后机械通气时间与ICU停留时间,B组均明显少于A组(均P<0.05)。结论:采用无气囊气管导管为支架更换早期气囊漏气的气管切开套管安全、可靠、有效,有利于改善氧合,可减少人机对抗,可更有效地控制肺部感染、缩短机械通气时间及ICU停留时间,值得临床推广。

Modified replacement of tracheostomy cannula with leak air bag

Objective：To explore the effect of modified replacement of tracheostomy cannula with leak air bag.Methods：A total of 72 cases with tracheostomy cannula with leak air bag were randomly divided into conventional group（A group）and modified group（B group）.Edotracheal catheter without air bag were used as frame in B group,and it was replaced as soon as the leakage occurred.The success rate,replacement time,incidence of dyspnea per day during leakage period and 3 days after replacement were observed.The phlegm as leak occurred and 5 days later were collected for culture,and the X-ray was employed.The arterial blood gas analysis was carried out,and duration of mechanism ventilation and ICU stay time were recorded.Results：Modified group showed higher success rate,and shorter replacement time,with lower incidence of decreasing SpO2 and fewer local hemorrahge.Replacement can significantly improve the oxygenation status,decrease incidence of over ventilation,dyspnea and bacterial infection in lung,and shorten ventilation duration and ICU stay time.Conclusions：Replacement of tracheostomy cannula with leak air using edotracheal catheter without air bag as frame is safe,reliable and effective.It can improve oxygenation status,decline the incidence of confrontion between patients and machine,control lung infection,and shorten entilation duration and ICU stay time.It is valuable in extensive clinical application.