作者：毕见龙1 ，罗阳1 ，殷娜1 ，尤玮1 ，王亚男2

单位：

1.102200北京市，北大医疗康复医院重症康复科　2.102200北京市，北大医疗康复医院高压氧科

Units：

1.Department of Critical Care Rehabilitation, Peking University Medical Rehabilitation Hospital, Beijing 102200, China 2.Hyperbaric Oxygen Department, Peking University Medical Rehabilitation Hospital, Beijing 102200, China

关键词：

卒中；气管切开术；高压氧；气囊管理；对比研究

Keywords：

Stroke; Tracheotomy; Hyperbaric oxygenation; Airbag management; Comparative study

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2024.00.109

Funds：

摘要：

目的　比较高压氧治疗期间不同气囊管理方法对行气管切开的脑卒中患者的影响。方法　选取2020 年1月—2023年1月北大医疗康复医院收治的行气管切开的脑卒中患者112例为研究对象，采用随机数字表法将其分为 对照组和观察组，每组56例。两组患者均接受高压氧治疗，其中对照组采用常规气囊压力监测方法，观察组采用气 囊注水联合气囊压力监测方法，10 d为1个疗程，共治疗2个疗程。比较两组应激反应指标（治疗前1 d、治疗期间及 治疗后1 d收缩压、舒张压、心率，治疗期间呼吸频率），治疗前1 d、治疗期间及治疗后1 d气囊压力和气道阻力， 肺炎（呼吸机相关性肺炎和院内获得性肺炎）发生率及治疗后3 d内不良反应发生率。结果　观察组治疗期间和治疗 后1 d收缩压、舒张压及气道阻力低于对照组，治疗期间心率、呼吸频率慢于对照组，治疗期间气囊压力高于对照组 （P＜0.05）。观察组呼吸机相关性肺炎发生率低于对照组（P＜0.05）。治疗后3 d内，观察组气道黏膜损伤、呛咳发 生率低于对照组（P＜0.05）。结论　高压氧治疗期间气囊注水联合气囊压力监测方法能有效减轻行气管切开的脑卒中 患者的应激反应，增加气囊压力，降低气道阻力及呼吸机相关肺炎、气道黏膜损伤、呛咳发生率。

Abstract：

Objective To compare the effect of different airbag management methods on stroke patients undergoing tracheotomy during hyperbaric oxygen therapy. Methods A total of 112 stroke patients who underwent tracheotomy in Peking University Medical Rehabilitation Hospital from January 2020 to January 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 56 cases in each group. Both groups received hyperbaric oxygen therapy. The control group was treated with conventional balloon pressure monitoring method, and the observation group was treated with balloon water injection combined with balloon pressure monitoring method, 10 d was a treatment course, with a total of two treatment courses. The stress response indexes (systolic blood pressure, diastolic blood pressure and heart rate at 1 d before treatment, during treatment and at 1 d after treatment, respiratory rate during treatment) , balloon pressure and airway resistance at 1 d before treatment, during treatment and at 1 d after treatment, the incidence of pneumonia (ventilator-associated pneumonia and nosocomial pneumonia) and the incidence of adverse reactions within 3 d after treatment were compared between the two groups. Results The systolic blood pressure, diastolic blood pressure and airway resistance during treatment and at 1 d after treatment in the observation group were lower than those in the control group, the heart rate and respiratory rate during treatment were slower than those in the control group, and the balloon pressure during treatment was higher than that in the control group (P < 0.05) . The incidence of ventilator-associated pneumonia in the observation group was lower than that in the control group (P < 0.05) . Within 3 days after treatment, the incidence of airway mucosal injury and bucking in the observation group was lower than that in the control group (P < 0.05) . Conclusion During hyperbaric oxygen therapy, balloon water injection combined with balloon pressure monitoring method can effectively reduce the stress response of stroke patients undergoing tracheotomy, increase balloon pressure, reduce airway resistance and the incidence of ventilator associated pneumonia, airway mucosal injury and bucking.

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