CAJ | 학술논문

目的总结早期机械通气联合气道持续负压吸引技术在治疗严重肺挫伤中的临床应用价值. 方法 48例严重肺挫伤机械通气患者按随机数字表法分为机械通气+持续负压吸引气道管理技术(持续组)20例和机械通气+间断负压吸引气道管理技术(间断组)28例,机械通气模式采用同步间歇指令通气(SIMV)+压力支持通气(PSV)+呼气末正压通气(PEEP),比较两组动脉血气、机械通气时间、相关并发症等指标的变化. 结果通气6,24 h后,观察组与对照组PaO2分别为(100.36±5.90) mmHg、(105.34 ± 7.40) mmHg、(75.36±8.95) mmHg、(76.36±8.35) mmHg(P ＜0.01),通气24 h后,两组氧合指数(PaO2/FiO2)分别为(283.50±15.20) mmHg、(201.50±10.20)mmHg(P ＜0.01);两组机械通气时间及通气48 h后PEEP水平分别为(3.2±1.1)d∶(6.5±2.8)d、(4.5±2.3)cmH2O∶(8.5±2.5)cmH2O(P＜0.01).两组相关并发症差异无统计学意义(P＞0.05). 结论严重肺挫伤患者早期机械通气联合气道持续负压吸引技术能持续保持呼吸道通畅,改善氧合指数,降低PEEP水平,利于较早拔管,但并不能降低呼吸机相关性肺炎及肺不张等并发症发生率.
목적 총결조기궤계통기연합기도지속부압흡인기술재치료엄중폐좌상중적림상응용개치. 방법 48례엄중폐좌상궤계통기환자안수궤수자표법분위궤계통기+지속부압흡인기도관리기술(지속조)20례화궤계통기+간단부압흡인기도관리기술(간단조)28례,궤계통기모식채용동보간헐지령통기(SIMV)+압력지지통기(PSV)+호기말정압통기(PEEP),비교량조동맥혈기、궤계통기시간、상관병발증등지표적변화. 결과 통기6,24 h후,관찰조여대조조PaO2분별위(100.36±5.90) mmHg、(105.34 ± 7.40) mmHg、(75.36±8.95) mmHg、(76.36±8.35) mmHg(P ＜0.01),통기24 h후,량조양합지수(PaO2/FiO2)분별위(283.50±15.20) mmHg、(201.50±10.20)mmHg(P ＜0.01);량조궤계통기시간급통기48 h후PEEP수평분별위(3.2±1.1)d∶(6.5±2.8)d、(4.5±2.3)cmH2O∶(8.5±2.5)cmH2O(P＜0.01).량조상관병발증차이무통계학의의(P＞0.05). 결론 엄중폐좌상환자조기궤계통기연합기도지속부압흡인기술능지속보지호흡도통창,개선양합지수,강저PEEP수평,리우교조발관,단병불능강저호흡궤상관성폐염급폐불장등병발증발생솔.
Objective To summarize the value of early mechanical ventilation plus continuous vacuum suction in treatment of serious pulmonary contusion.Methods Forty-eight cases of severe pulmonary contusion were assigned to mechanical ventilation plus continuous vacuum suction (observation group,n =20) and mechanical ventilation plus discontinuous vacuum suction (control group,n =28)according to the random number table.Modes of mechanical ventilation were synchronized intermittent mandatory ventilation (SIMV),pressure support ventilation (PSV),and positive and expiratory pressure (PEEP).Changes in blood gas analysis,mechanical ventilation time,and associated complications were compared between groups.Results At ventilation time of 6 and 24 hours,PaO2 in observation group was (100.36 ± 5.90) mmHg and (105.34 ± 7.40) mmHg respectively,with significant differences from (75.36 ± 8.95) mmHg and (76.36 ± 8.35) mmHg in control group (P ＜ 0.01).At ventilation time of 24 hours,PaO2/FiO2 was (283.50 ± 15.20) mmHg in observation group and (201.50 ± 10.20) mmHg in control group (P ＜0.01).Mechanical ventilation time and PEEP at ventilation time of 48 hours in observation group was (3.2 ± 1.1) days and (4.5 ± 2.3) cmH2 O,with significant differences from (6.5 ± 2.8) days and (8.5 ± 2.5) cmH2O in control group (P ＜ 0.01).Associated complications of the two groups revealed no significant difference (P ＞ 0.05).Conclusion Early mechanical ventilation with sustained vacuum suction is effective to keep airway clear,improve oxygenation index,decrease PEEP level,and control the duration of mechanical ventilation,but may not lower the risks of ventilator-associated pneumonia and pulmonary atelectasis.