不同吸痰方式对重型颅脑损伤患者早期肺通气功能和肺部感染的影响

摘要

目的：探讨不同吸痰方式对重型颅脑损伤患者早期肺通气功能和肺部感染的影响。方法选择2013年6月—2014年6月河南省安阳市中医院神经外科收治的重型颅脑损伤住院患者95例，采用随机数字表法分为对照组47例和观察组48例。对照组患者在气管切开术早期给予常规吸痰方法，观察组患者在气管切开术早期给予浅部吸痰与纤维支气管镜灌洗吸痰相结合的优化吸痰方法。比较两组患者气管切开前及气管切开后第2、3、5、7天动脉血气分析结果，包括动脉血氧分压（ PaO2）、动脉血二氧化碳分压（ PaCO2）和氧合指数；记录两组患者气道黏膜出血发生率和肺部感染发生率。结果两组患者气管切开前PaO2、PaCO2及氧合指数比较，差异无统计学意义（ P>0.05）；观察组患者气管切开后第2、3、5、7天PaO2和氧合指数高于对照组，气管切开后第2、7天PaCO2低于对照组（P<0.05）。观察组患者黏膜出血率为22.9%、肺部感染率为27.1%，低于对照组的44.7%、46.8%（ P<0.05）。结论浅部吸痰与纤维支气管镜灌洗吸痰相结合的优化吸痰方法能有效改善重型颅脑损伤患者早期肺通气功能，降低气道黏膜出血和肺部感染等并发症的发生。%Objective To investigate the impact of different sputum suction methods on early pulmonary ventilation function and lung infection of patients with severe craniocerebral injury. Methods From June 2013 to June 2014,a total of 95 patients with severe craniocerebral injury were selected in the Department of Neurosurgery,Traditional Chinese Medicine Hospital of Anyang,and they were divided into control group(n=47)and observation group(n=48)according to random number table. Patients of control group were given conventional sputum suction at the early stage of tracheotomy, while patients of observation group were given shallow sputum suction combined with fiberoptic bronchoscopy lavage sputum suction at the early stage of tracheotomy. PaO2 ,PaCO2 and PaO2/FiO2 were compared between the two groups before and 2 days,3 days,5 days, 7 days after tracheotomy,and incidence of airway mucosa bleeding and lung infection were recorded. Results No statistically significant differences of PaO2,PaCO2 or PaO2/FiO2 was found between the two groups before tracheotomy(P>0. 05);PaO2 and PaO2/FiO2 of observation group were significantly higher than those of control group 2 days,3 days,5 days,7 days after tracheotomy,respectively(P<0. 05),while PaCO2 of observation group were significantly lower than those of control group 2 days,7 days after tracheotomy, respectively ( P <0. 05 ). The incidence of airway mucosa bleeding and lung infection of observation group was 22. 9%,27. 1%,respectively,was significantly lower that of control group of 44. 7%,46. 8%, respectively( P<0. 05 ). Conclusion Shallow sputum suction combined with fiberoptic bronchoscopy lavage sputum suction can effectively improve the early pulmonary ventilation function of patients with severe craniocerebral injury,reduce the incidence of airway mucosa bleeding and lung infection.