摘要
目的比较机械通气自主呼吸试验成功患者正压拔管与负压拔管对减少拔管相关并发症的效果。方法选择2019年7月1日—12月31日某三级甲等医院ICU自主呼吸试验成功后的患者48例,采用随机数字表将入组患者分为正压拔管组(25例)和负压拔管组(23例),主要观察指标为患者在拔管过程中呼气末电阻(end expiratory lung impedance,EELI)的变化率,用△EELI%表示。次要观察指标包括患者呼吸频率、心率、平均动脉压、血氧饱和度变化;上呼吸道并发症包括气道高反应(喉部喘鸣、两肺新发哮鸣音)、严重咳嗽、胃内反流和呼吸窘迫。结果正压拔管组拔管前后△EELI%为(14.84±2.03)%,EELI平均1 min内全部恢复至拔管前水平;负压拔管组拔管前后△EELI%为(31.09±4.64)%,EELI恢复至拔管前水平所需平均时间为3 min,其中4例在拔管后30 min内EELI仍低于拔管前水平,两组△EELI%比较差异有统计学意义(P<0.05);拔管30 min内并发症发生例数比较:呼吸急促(正压拔管组、负压拔管组分别为5例,15例),心率增加20%(4例,11例),平均动脉压增加20%(2例,8例),血氧饱和度下降超过5%(2例,8例);上呼吸道并发症包括气道高反应(1例,6例),严重咳嗽(3例,9例),以及胃内反流(1例,6例)和呼吸窘迫(2例,10例),两组比较差异有统计学意义(P<0.05)。结论正压拔管可以有效减少机械通气患者因拔管导致的肺塌陷,降低上呼吸道并发症的发生率。
Objective To compare the impact of positive pressure extubation and negative pressure extubation on extubation complications in patients with successful spontaneous breathing test.Methods 48 patients with successful spontaneous breathing trial in a first-class level hospital from July 1,2019 to December 31,2019 were enrolled and were divided into positive pressure extubation group(25 cases)and negative pressure extubation group(23 cases)using a random number table.End Expiratory Lung Impedance changes(delta EELI%)was a primary observation index.Secondary observation indexes included breathing rate,heart rate,mean arterial pressure,blood oxygen saturation changes and upper airway complications which included airway hyperresponsiveness(wheezing in the larynx,new wheezing in both lungs),severe coughing,and respiratory distress.Results In the positive pressure extubation group,EELI%decreased by(14.84±2.03)%after extubation,and all EELI returned to the level before extubation within an average of one minute.In the negative pressure extubation group,the EELI%decreased by(31.09±4.64)%after extubation,the average time for EELI to return to the level before extubation was 3 minutes,and the EELI within 30 minutes after extubation in 4 patients was still lower than the level before extubation.The difference between the two groups was statistically significant(P<0.05).The number of complications occurred within 30 minutes after extubation was compared between the two groups.Shortness of breath occurred in 5 cases vs.15 cases in positive pressure vs.negative pressure group.HR increased by 20%(4 cases vs.11 cases),MAP increased by 20%(2 cases vs.8 cases),SpO2 decreased by more than 5%(2 cases vs.8 cases),and SpO2 decreased by more than5%(2 cases vs.8 cases).Upper airway complications included airway hyperresponsiveness(1 vs.6 cases),severe cough(3 vs.9 cases),and gastric reflux(1 vs.6 cases)and respiratory distress(2 vs.10 cases).The differences of complications were statistically significant between two groups(P<0.05).Conclusion Positive pressure extubation can effectively reduce the pulmonary collapse caused by extubation and reduce the incidence of upper airway complications.
作者
徐培峰
李晓东
葛慧青
XU Peifeng;LI Xiaodong;GE Huiqing
出处
《中华急危重症护理杂志》
2020年第6期512-515,共4页
Chinese Journal of Emergency and Critical Care Nursing
关键词
气道拔管
拔管方式
肺不张
低氧血症
气道内吸引
电阻抗断层成像技术
Airway Extubation
Extubation Methods
Pulmonary Atelectasis
Hypoxemia
Endotracheal Suctioning
Electrical Impedance Tomography
