机械通气患者不同粘稠度分泌物持续声门下吸引负压值的选择

摘要

Objective To explore the effect of continuous aspiration of subglottic secretion at different negative pressure levels on mechanical ventilation. Methods Toally 142 patients were randomized by way of lottery into the control group (n=70) and the experiment group ( n = 72 ): the control group received continuous negative pressure aspiration of subglottic secretion at a negative pressure of 60 mmHg while the experiment group did 30~40 mmHg for grade I of the sticky secretion , 40~60 mmHg for gradeⅡ~Ⅲof the sticky secretion, respectively. The two groups were compared in terms of the rate of ventilator associated pneumonia (VAP), airway mucosal injury and cough. Result There was no significant difference in the rate of ventilator associated pneumonia (P>0.05), but the rates of airway mucosal injury and cough were lower in the experiment group than those of the control group (P < 0.05). Conclusion It is reasonable to choose different negative pressure levels based on stickiness of the secretions for mechanical ventilation, for it can prevent the ventilator associated pneumonia and airway mucosal injury.%目的：探讨机械通气患者不同粘稠度分泌物持续声门下吸引负压值的选择。方法采用抽签法将142例机械通气患者分为对照组70例和试验组72例，两组均行持续声门下吸引，对照组吸引负压为60 mmHg；试验组根据分泌物粘稠度选择吸引的负压值，Ⅰ度分泌物选用30～40 mmHg的负压，Ⅱ度和Ⅲ度分泌物选用40～60 mmHg的负压。观察两组患者呼吸机相关性肺炎（ventilator associated pneumonia ，VAP）、气道黏膜损伤和呛咳发生情况。结果两组患者VAP发生率比较，差异无统计学意义（P＞0．05）。试验组患者气道黏膜损伤和呛咳发生率低于对照组，两组比较，差异均有统计学意义（均P＜0．05）。结论对机械通气患者在应用持续声门下吸引时，根据分泌物的粘稠度采用不同负压，在预防VAP发生的同时可降低呼吸道黏膜的损伤。