肺结核行机械通气患者序贯排痰方案的构建及应用

目的 探讨序贯排痰方案在肺结核行机械通气治疗患者中的应用效果。方法 选取2018年1月—12月南宁市某三级甲等传染病医院45例肺结核行机械通气患者为试验组,2017年1月—12月44例肺结核行机械通气患者为对照组,其中试验组采用序贯排痰方案,对照组使用常规排痰方案。干预24 h后,比较两组呼吸频率、平均动脉压、血氧饱和度、动脉血氧分压、氧合指数、动脉血CO₂分压、气道峰压值、日排痰量。比较两组干预7 d后排痰效果、呼吸机相关性肺炎发生率、机械通气时间、ICU住院时间、脱机成功率等指标。结果 干预24 h后,两组呼吸频率较干预前显著降低（P<0.05）,两组平均动脉压波动较干预前无明显变化（P>0.05）,试验组血氧饱和度、动脉血氧分压值、氧合指数较对照组及干预前有所升高（P<0.05）,气道峰压和动脉血CO₂分压较对照组及干预前均显著降低（P<0.05）,试验组日排痰量（29.48±4.54） ml,对照组（12.56±2.287） ml,两组比较,差异具有统计学意义（P<0.001）;干预7 d后,试验组排痰效果优于对照组（P<0.05）;干预后试验组呼吸机相关性肺炎发生率、机械通气时间、ICU住院时间均低于对照组,脱机成功率高于对照组（P<0.05）。结论 应用序贯排痰方案能促进肺结核机械通气患者痰液排出,改善患者的肺功能状态,提高生存质量,缩短ICU住院时间并减轻医疗负担。

Construction and application of sequential sputum excretion scheme in pulmonary tuberculosis patients with mechanical ventilation

Objective To investigate the effect of sequential sputum excretion scheme on pulmonary tuberculosis patients treated with mechanical ventilation.Methods Forty-five pulmonary tuberculosis patients with mechanical ventilation were selected as the experimental group from January to December 2018,and received sequential sputum excretion scheme;while 44 patients were recruited as the control group from January to December 2017 receiving routine sputum management. Breathing rate,mean arterial pressure,blood oxygen saturation,arterial oxygen partial pressure,artery oxygenation index,CO₂ partial pressure,airway peak pressure value,the amount of sputum drainage,effect of sputum excretion,incidence of ventilator-associated pneumonia,length of mechanical ventilation,length of ICU stay,and success rate of ventilator weaning were compared between two groups.Results After 24 hours of intervention,there was significant difference in breathing rate and no significant difference in mean arterial pressure fluctuation before intervention in two groups,but blood oxygen saturation,arterial oxygen partial pressure and oxygenation index in the experimental group were higher than those in the control group and before intervention（P<0.05）. After intervention,the peak airway pressure and arterial CO₂ partial pressure in the experimental group were significantly lower than those in the control group and before intervention（P<0.05）. After 24 hours of intervention,the daily sputum excretion in the experimental group（29.48±4.54） ml was significantly higher than the control group（12.56±2.287） ml（P<0.001）. After 7 days of intervention,the effect of sputum excretion in the experimental group was better than the control group（P<0.05）. Compared with the control group,the incidence of ventilator-associated pneumonia,the length of mechanical ventilation and the length of ICU stay in the experimental group were lower and shorter,and the success rate of ventilator weaning was higher（P<0.05）.Conclusion Sequential sputum excretion scheme can promote the discharge of sputum in pulmonary tuberculosis patients with mechanical ventilation,improve pulmonary function and quality of life,shorten length of stay in ICU and reduce medical burden.