CAJ | 학술논문

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.
목적 탐토개진적뉴식면조재무창통기중적사용효과.방법 선택만성조새성폐부질병병Ⅱ형호흡쇠갈행무창정압통기환자78례,안수궤수자표법수궤분위대조조40례화관찰조38례,량조균사용뉴식면조,장흡담관류치기관내,흡담관미단종뉴식면조하방여면부접합처천출.대조조흡담시,선정용무창통기,개용단측비도관흡양후흡담；관찰조흡담시,불중단무창통기,통과면조흡담흡담,비교량조흡담효과.결과 량조무창통기치료24h,양분압(PaO2)화이양화탄분압(PaCO2)차이무통계학의의(t분별위0.84,1.07;P균＞0.05)；무창통기48 h,관찰조적PaO2화PaCO2분별위(61.53±9.94)、(64.02±10.37)mm Hg,대조조분별위(56.57±11.19)、(69.55±12.73)mm Hg,량조비교차이유통계학의의(t분별위2.07,2.10；P균＜0.05)；무창통기96h,량조비교차이유통계학의의(t분별위3.87,3.03；P균＜0.01).관찰조루계응용정압통기총시간(152.23±25.91)h,소우대조조적(169.57±33.49)h,차이유통계학의의(t=2.54,P＜0.05).결론 무창정압통기적환자,선용대흡담측공면조진행통기,흡담시불수중단무창통기,가감소병발증,회복시간단,치료효과호.
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.