CAJ | 학술논문

目的分析内科重症监护病房(ICU)与专科ICU有创机械通气患者常见呼吸机报警原因及相关处理策略.方法选择中国医科大学附属第一医院2011年1月至12月内科ICU及专科ICU收治的有创机械通气患者,对需由一线医生、呼吸治疗师及上级医师或由内科ICU会诊处理的呼吸机报警、报警原因进行分析比较.结果内科ICU 59例患者共发生375次呼吸机报警,前3位报警参数的发生率为气道高压21.87％、高潮气量15.73％、高分钟通气量14.13％；专科ICU 249例患者共发生403次呼吸机报警,前3位报警参数的发生率为气道高压32.51％、气道低压15.38％、高呼吸频率10.42％.内科ICU中气道高压、气道低压报警率明显低于专科ICU(21.87％比32.51％,8.53％比15.38％,均P＜0.01),高分钟通气量、高潮气量报警率高于专科ICU(14.13％比7.20％,15.73％比9.68％,P＜0.01和P＜0.05).内科ICU前3位报警原因为雾化吸入、痰液堵塞、氧电池过期,专科ICU为痰液堵塞、呼吸窘迫、管道漏气和氧电池过期；内科ICU由于痰液堵塞、管道因素(气管插管位置改变、管道积水)、报警参数设置不当为原因的报警率明显低于专科ICU(10.93％比17.12％,1.87％比4.47％,1.33％比3.72％,1.60％比3.97％,均P＜0.05),由于雾化吸入导致的呼出端过滤器严重堵塞、高潮气量、高分钟通气量为原因的报警率明显高于专科ICU(18.93％比3.97％,P＜0.01).结论内科ICU及专科ICU均应了解各科呼吸机报警特点,有针对性地预防,及时发现问题并进行相关处理.
목적 분석내과중증감호병방(ICU)여전과ICU유창궤계통기환자상견호흡궤보경원인급상관처리책략.방법 선택중국의과대학부속제일의원2011년1월지12월내과ICU급전과ICU수치적유창궤계통기환자,대수유일선의생、호흡치료사급상급의사혹유내과ICU회진처리적호흡궤보경、보경원인진행분석비교.결과 내과ICU 59례환자공발생375차호흡궤보경,전3위보경삼수적발생솔위기도고압21.87％、고조기량15.73％、고분종통기량14.13％；전과ICU 249례환자공발생403차호흡궤보경,전3위보경삼수적발생솔위기도고압32.51％、기도저압15.38％、고호흡빈솔10.42％.내과ICU중기도고압、기도저압보경솔명현저우전과ICU(21.87％비32.51％,8.53％비15.38％,균P＜0.01),고분종통기량、고조기량보경솔고우전과ICU(14.13％비7.20％,15.73％비9.68％,P＜0.01화P＜0.05).내과ICU전3위보경원인위무화흡입、담액도새、양전지과기,전과ICU위담액도새、호흡군박、관도루기화양전지과기；내과ICU유우담액도새、관도인소(기관삽관위치개변、관도적수)、보경삼수설치불당위원인적보경솔명현저우전과ICU(10.93％비17.12％,1.87％비4.47％,1.33％비3.72％,1.60％비3.97％,균P＜0.05),유우무화흡입도치적호출단과려기엄중도새、고조기량、고분종통기량위원인적보경솔명현고우전과ICU(18.93％비3.97％,P＜0.01).결론 내과ICU급전과ICU균응료해각과호흡궤보경특점,유침대성지예방,급시발현문제병진행상관처리.
Objective To analyze the common reasons of invasive ventilator alarms between medical intensive care unit (ICU) and specialist ICU,and its related management methods.Methods Patients admitted to medical ICU and specialist ICU from January to December in 2011 of the First Hospital of China Medical University were studyed.Ventilator alarms and their reasons need to be handle by the front-line doctors,respiratory therapists,attending physicians or medical ICU doctors were analyzed and compared.Results There were 375 ventilator alarms of the 59 patients in the medical ICU,incidence of the top three alarms parameters were high airway pressure alarms for 21.87％,high tide volume alarms for 15.73％ and high minute ventilation alarms for 14.13％.In specialist ICU there were a total of 403 ventilator alarms with 249 patients,incidence of the top three alarms parameters were high airway pressure alarms for 32.51％,low airway pressure alarms for 15.38％,high respiratory rate alarms for 10.42％.The incidence of high airway pressure and low airway pressure alarms in medical ICU were significantly lower than the specialist ICU (21.87％vs.32.51％,8.53％ vs.15.38％,both P＜0.01),and the incidence of high minute ventilation and high tidal volume alarms in medical ICU were higher than specialist ICU (14.13％ vs.7.20％,15.73％ vs.9.68％,P＜0.01 and P＜0.05).The top three causes of the alarms were aerosol inhalation,sputum blockage,and oxygen battery expired in medical ICU,and sputum blockage,respiratory distress,and pipeline leak and oxygen expired battery in specialist ICU.The reasons of sputum blockage,tubes factors (intubation position change,pipeline water) and improper alarm parameters setting in medical ICU was significantly lower than those in specialist ICU ( 10.93％ vs.17.12％,1.87％ vs.4.47％,1.33％ vs.3.72％,1.60％ vs.3.97％,all P＜0.05).High tidal volume,high minute ventilation and serious breath-side filter blockage because of aerosol inhalation in medical ICU were significantly higher than those in specialist ICU ( 18.93％ vs.3.97％,P＜0.01 ).Conclusion Doctors in medical ICU and specialist ICU should understand the ventilator alarms characteristics,prevention,detect and timely problems management.