作者：王妮娜，陈洋，高宏彪，陈圆媛，吴天姿，余娟，刘晓红

单位：

225000 江苏省扬州市，扬州大学附属医院重症医学科

Units：

ICU，Affiliated Hospital of Yangzhou University，Yangzhou 225000，China

关键词：

呼吸，人工；气管切开术；声门下吸引；冲洗时间；疗效比较研究

Keywords：

Respiration，artificial；Tracheotomy；Subglottic secretion suction；Washing time；Comparative effectiveness research

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.013

Funds：

摘要：

背景　声门下吸引技术是临床防治机械通气患者发生呼吸机相关性肺炎（VAP）的常用方法，目前国 内主要针对声门下吸引技术的负压水平、冲洗液种类、间隔时间等进行了初步研究，而对声门下单次冲洗时间的相关研究较罕见。目的　比较不同声门下单次冲洗时间对气管切开术后机械通气患者临床效果及 28 d 病死率的影响。方法　选取 2017 年 12 月—2019 年 12 月扬州大学附属医院重症医学科（ICU）收治的气管切开术后机械通气患者 120 例，随机分为A、B、C组，各40例。患者均给予声门下吸引技术治疗，其中A、B、C组患者声门下单次冲洗时间分别为5 s、10 s、15 s。比较三组患者心率、血氧饱和度（SpO 2 ）、平均动脉压（MAP）、机械通气时间、ICU 住院时间、不良事件发生率及28 d病死率。结果　三组患者心率、SpO 2 、VAP发生率及28 d病死率比较，差异无统计学意义（P＞0.05）。三组患者 MAP、机械通气时间、ICU 住院时间及呛咳、肉眼可见血性液体、吸引管堵塞发生率比较，差异有统计学意义（P ＜ 0.05）；其中 B 组患者 MAP、肉眼可见血性液体发生率低于 A、C 组，机械通气时间短于 A、C 组，ICU 住院时间短于 C 组，呛咳、吸引管堵塞发生率低于 A 组（P ＜ 0.05）。结论　声门下单次冲洗时间为 10 s 时可更有效地降低气管切开术后机械通气患者 MAP，缩短机械通气时间及 ICU 住院时间，安全性较高，且不会增加 28 d 病死率。

Abstract：

Background　Subglottic aspiration technique is a common method in preventing and treating ventilator-associated pneumonia（VAP） in mechanical ventilation patients.In China，the negative pressure level，flushing fluid types，interval time of subglottic suction technology are mainly studied，and the relative study of single subglottic washing time is rare. Objective　To compare different single subglottic washing time on clinical effect and 28 d mortality of mechanically ventilated patients after tracheotomy.Methods　A total of 120 cases of patients who had been treated with mechanically ventilated after tracheotomy in ICU of Affiliated Hospital of Yangzhou University from December 2017 to December 2019，and they were randomly divided into group A，group B and group C，40 cases in each group.Patients were treated with subglottic aspiration technique，single subglottic washing time of group A，group B and group C was 5 s，10 s，15 s，respectively.Heart rate，oxygen saturation（SpO 2 ），mean arterial pressure（MAP），mechanical ventilation time，ICU hospitalization time，incidence of adverse events and 28 d mortality were compared in the three groups.Results　There was no significant difference in heart rate，SpO 2 ，incidence of VAP and 28 d mortality among the three groups（P ＞ 0.05）.There were significant differences in MAP，mechanical ventilation time，ICU hospitalization time and incidence of choking cough，bloody liquid visible to the naked eye，blocked suction catheter among the three groups（P ＜ 0.05）；MAP，incidence of bloody liquid visible to the naked eye in group B were lower than those in groups A and C，mechanical ventilation time was shorter than that in groups A and C，ICU hospitalization time was shorter than that in group C，incidence of choking cough，blocked suction catheter were lower than those in group A（P ＜ 0.05）.Conclusion　10 s of single subglottic washing time can more effectively reduce MAP，shorten mechanical ventilation time and ICU hospitalization time of mechanically ventilated patients after tracheotomy，the safety is higher，and will not increase the 28 d mortality.

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