改进呼吸面罩在无创正压通气吸痰中的应用

摘要

目的 探讨改进的纽式面罩在无创通气中的使用效果.方法 选择慢性阻塞性肺部疾病并Ⅱ型呼吸衰竭行无创正压通气患者78例,按随机数字表法随机分为对照组40例和观察组38例,两组均使用纽式面罩,将吸痰管留置气管内,吸痰管尾端从纽式面罩下方与面部接合处穿出.对照组吸痰时,先停用无创通气,改用单侧鼻导管吸氧后吸痰；观察组吸痰时,不中断无创通气,通过面罩吸痰吸痰,比较两组吸痰效果.结果 两组无创通气治疗24h,氧分压(PaO2)和二氧化碳分压(PaCO2)差异无统计学意义(t分别为0.84,1.07;P均＞0.05)；无创通气48 h,观察组的PaO2和PaCO2分别为(61.53±9.94)、(64.02±10.37)mm Hg,对照组分别为(56.57±11.19)、(69.55±12.73)mm Hg,两组比较差异有统计学意义(t分别为2.07,2.10；P均＜0.05)；无创通气96h,两组比较差异有统计学意义(t分别为3.87,3.03；P均＜0.01).观察组累计应用正压通气总时间(152.23±25.91)h,少于对照组的(169.57±33.49)h,差异有统计学意义(t=2.54,P＜0.05).结论 无创正压通气的患者,选用带吸痰侧孔面罩进行通气,吸痰时不需中断无创通气,可减少并发症,恢复时间短,治疗效果好.%Objective To explore the effect of improved new mask in noninvasive positive pressure ventilation sputum suction.Methods Among the patients with chronic obstructive pulmonary disease and type Ⅱ respiratory failure,78 patients were selected and divided randomly into observation group (n =38 ) and control group (n =40).Both groups implemented the noninvasive ventilation and symptomatic treatment.The endotracheal suction tube was left in patients for 96 hours,the end of which passes the junction part of the mask and the face.For the control group,the process of ventilation was interrupted for sputum suction,while for the observation group; the process of ventilation kept on without interruption due to the side hole on the mask for suction.In the interval of sputum suction,the same airway humidification fluid was injected into the suction tube regularly for both groups.Results When the observation group and the control group had accepted the noninvasive ventilation simultaneously for 24 hours,the oxygen and carbon dioxide partial pressure difference was not statistically significant(t =0.84,1.07;P ＞ 0.05).While for 48 hours,the oxygen and carbon dioxide partial pressure difference was statistically significant [ (61.53 ±9.94) mm Hg versus (56.57 ± 11.19) mm Hg,t =2.07,P ＜ 0.05 ; (64.02 ± 10.37 ) mm Hg versus ( 69.55 ± 12.73 ) mm Hg,t =2.10,P ＜ 0.05 ].and for 96 hours,the oxygen and carbon dioxide partial pressure difference was also statistically significant [ (69.35 ±9.37) mm Hg versus (60.57 ± 10.64) mm Hg,t =3.87,P ＜ 0.01 ; ( 55.82 ± 10.58 ) mm Hg versus ( 61.55 ±11.73 ) mm Hg,t =3.03,P ＜ 0.01 ].The difference of the time it took for the patients to got conscious in both groups was statistically significant[ (21.21 ±7.24) h versus (25.35 ±9.28) h,t =2.17,P ＜0.05].The difference of the number of cases with the application of invasive ventilation in the end of two groups was statistically significant (x2 =4.78,P ＜ 0.05 ).The difference of the total time with the application of positive ventilation of two groups was statistically.significant [ ( 152.23 ± 25.91 ) h versus ( 169.57 ± 33.49 ) h,t =2.54,P ＜ 0.05 ].Conclusions The mask with a side hole for sputum suction and endotracheal suction tubes can be applied to the patients of the chronic obstructive pulmonary disease combined with the Ⅱ respiratory failure.Without the interruption of the noninvasive ventilation,sputum suction has significant reduction in complications,and the patients can have a shorter recovery time,better treatment effect,and smaller rate of invasive ventilation.