CAJ | 학술논문

目的：探讨高频胸壁振荡排痰仪在心脏外科术后应用的耐受性、安全性和临床效果。方法将2013年8—10月接受心脏外科手术的患者，随机分为高频振荡排痰（HFCWO）组和人工叩背组。对每次治疗的耐受性、舒适度和疼痛进行评估，并观察患者初次 HFCWO 治疗前10 min、治疗中和治疗结束后10 min 的循环和呼吸指标（心率、血压、中心静脉压、呼吸频率和氧饱和度）的变化。比较两组患者的排痰效果和临床结局。结果患者两次治疗前10 min、治疗中和治疗后10 min 的各项循环指标，两组差异无统计学意义（P ＞0.05）。第1次和第2次治疗时 HFCWO 组在耐受性和舒适感评估与人工叩背组有差异（P ＜0.05）；而两组在疼痛程度评估和是否中断治疗差异无统计学意义（P ＞0.05）。HFCWO组患者的排痰量10.0~22.5 ml，优于人工叩背组的5.0~10.0 ml，差异有统计学意义（Z =-5.069，P ＜0.05）。临床结局方面，两组患者无一例发生胸腔积液和二次气管插管，在术后肺膨胀不全、肺部感染、ICU 滞留时间和住院时间方面，两组差异无统计学意义（P ＞0.05）。结论 HFCWO 在心脏外科手术后拔除气管插管后早期应用是安全的，且能被大多数患者很好耐受，其排痰效果优于人工叩背。
목적：탐토고빈흉벽진탕배담의재심장외과술후응용적내수성、안전성화림상효과。방법장2013년8—10월접수심장외과수술적환자，수궤분위고빈진탕배담（HFCWO）조화인공고배조。대매차치료적내수성、서괄도화동통진행평고，병관찰환자초차 HFCWO 치료전10 min、치료중화치료결속후10 min 적순배화호흡지표（심솔、혈압、중심정맥압、호흡빈솔화양포화도）적변화。비교량조환자적배담효과화림상결국。결과환자량차치료전10 min、치료중화치료후10 min 적각항순배지표，량조차이무통계학의의（P ＞0.05）。제1차화제2차치료시 HFCWO 조재내수성화서괄감평고여인공고배조유차이（P ＜0.05）；이량조재동통정도평고화시부중단치료차이무통계학의의（P ＞0.05）。HFCWO조환자적배담량10.0~22.5 ml，우우인공고배조적5.0~10.0 ml，차이유통계학의의（Z =-5.069，P ＜0.05）。림상결국방면，량조환자무일례발생흉강적액화이차기관삽관，재술후폐팽창불전、폐부감염、ICU 체류시간화주원시간방면，량조차이무통계학의의（P ＞0.05）。결론 HFCWO 재심장외과수술후발제기관삽관후조기응용시안전적，차능피대다수환자흔호내수，기배담효과우우인공고배。
Objective To evaluate the tolerability,safety and efficacy of High-frequency Chest Wall Oscillation System Expectoration( HFCWO)after cardiac surgery. Methods Patients in August to October 2013 undergoing cardiac surgery were randomly divided into HFCWO group and percussion on back group. The tolerability,comfort and pain were assessed,and the changes of circulatory and respiratory parameters such as heart rate,blood pressure,central venous pressure,breathing rate and pulse oxygen saturation were measured 10 min before,during and 10 min after HFCWO and percussion on back therapy. Moreover,the efficacy of sputum excretion and related clinical outcome were compared between two groups. Results Ten minutes before, during and 10 minutes after treatment,each circulatory parameters had no statistical significance(P > 0. 05). At the first and second treatment,the tolerility and comfort of HFCWO group had a statistical difference with percussion on back group(P < 0. 05). The volume of sputum elimination in HFCWO group was 10. 0 - 22. 5 ml better than 5. 0 - 10. 0 ml( Z = - 5. 069,P < 0. 05). In respect of curative effects,there were no cases happened pleural effusion second trachea intubation in two groups,but postoperative atelectasis,pulmonary infection,the length of ICU stay and hospitalization had no significance(P > 0. 05). Conclusions HFCWO is a safe and well-tolerated equipment in patients after extubation following cardiac surgery,and is better than percussion on back group in sputum expectoration.