气道湿化后不同痰液黏稠度下吸痰对患者循环呼吸的影响

摘要

目的：探讨气道湿化后不同痰液黏稠度下吸痰对患者循环呼吸的影响，为达到最佳人工气道湿化提供参考依据。方法选取气管切开行机械通气患者60例，根据呼吸机加温湿化后患者痰液黏稠度不同分为Ⅰ度、Ⅱ度、Ⅲ度3组，每组20例，比较每组患者吸痰前后不同时间点心率（HR）、平均动脉压（MAP）、呼吸频率（RR）、血氧饱和度（SPO2）、气道峰压（Ppeak）、肺动态顺应性（Cd）的变化。结果三组患者 SPO2吸痰后与吸痰前（基线水平）相比差异无统计学意义（P＞0．05）。Ⅰ度组和Ⅲ度组在吸痰后5 min HR 、MAP 、RR 、Ppeak 、Cd 与基线水平及同时段Ⅱ度组相比差异有统计学意义（P＜0．05）。Ⅰ度组 Ppeak 、Cd 在吸痰后10 min 较基线水平与同时段Ⅱ度组差异有统计学意义（P＜0．05），且 Cd 在吸痰后15 min 与同时段Ⅱ度组差异有统计学意义（P＜0．05）。Ⅲ度组在吸痰后10、15 min Ppeak 、Cd 较基线水平及同时段Ⅱ度组差异有统计学意义（P ＜0．05）。Ⅱ度组仅在吸痰后5 min Ppeak 较基线水平差异有统计学意义（P＜0．05）。结论进行人工气道湿化后，当患者痰液黏稠度为Ⅱ度水平时，吸痰对患者循环及呼吸的影响最小。%Objective To investigate the influence of sputum suction under different sputum viscosity degrees after airway humidification on circulation and respiration to provide reference basis for reaching the optimum artificial airway humidification .Methods Totally 60 patients with tracheotomy undergoing mechanical ventilation were select-ed and divided into the group Ⅰ ,Ⅱ and Ⅲ (n= 20) according to the sputum viscosity after breathing machine war-ming humidification .The changes of heart rate (HR) ,mean arterial pressure (MAP) ,respiratory frequency (RR) , blood oxygen saturation (SPO2 ) ,airway peak pressure (Ppeak) and dynamic lung compliance (Cd) at different time points before and after sputum suction were compared among 3 groups .Results SPO2 in 3 groups had no statistical difference between after and before sputum suction(baseline level) (P > 0 .05) .HR ,MAP ,RR ,Ppeak and Cd at 5 min after sputum suction in the group Ⅰ and Ⅲ had statistical differences compared with the baseline levels and the group Ⅱ at the same time point (P< 0 .05) .Ppeak and Cd at 10 min after sputum suctioning in the group Ⅰ had sta-tistical difference compared with the baseline levels and the Ⅱ at the same time point (P< 0 .05) ,moreover Cd at 15 min after sputum suction had statistical difference compared with the group Ⅱ at the same time point (P < 0 .05) . Ppeak and Cd at 10 ,15 min after sputum suctioning in the group Ⅲ had statistical difference compared with the base-line levels and the group Ⅱ at the same time point (P< 0 .05) .Ppeak only at 5 min after sputum suction in the groupⅡ had statistical difference compared with the baseline level (P< 0 .05) .Conclusion In the sputum viscosity degreeⅡ after artificial airway humidification ,sputum suction has minimal influence on circulation and respiration of pa-tients .