ISSN 2096-7446　CN 10-1655/R
主管：中国科协技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 ›› 2020, Vol. 1 ›› Issue (6): 512-515.

• 临床研究 • 上一篇    下一篇

不同拔管方式对气管导管拔除患者并发症影响的研究

徐培峰 李晓东 葛慧青   

  1. 浙江大学医学院附属邵逸夫医院呼吸治疗科

  • 收稿日期:2020-09-17 出版日期:2020-11-10 发布日期:2020-11-27

The impact of two methods of extubation onthe occurrence of extubation complications

XU Peifeng， LI Xiaodong， GE Huiqing   

  • Received:2020-09-17 Online:2020-11-10 Published:2020-11-27

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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 lungimpedance , 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EEII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。

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

Abstract:

Objective To compare the impact of positive pressure extubation and negative pressure extubation on extubation complications in patents 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 ex tu bation 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 observ ation indexes included breathing rate ,heart rate , mean arterial pressure, blood oxygensaturation changes and upper airw ay complications which included airway hy perresponsiveness (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 returmned to the level before extubation within an average of one minute. In the negative pressure extubation group, the EELI% decreased by(3 1.09+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 than 5%(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.

Key words:

Airway Extubation;Extubation Methods;Pulmonary Atelectasis, Hypoxemia;Endotracheal Suctioning, Electrical Impedance Tomography