论文部分内容阅读
目的研究在气道分泌物较多或吸入异物的有创通气患者中,行纤维支气管镜治疗后应用肺复张策略的治疗效果。方法 2012年9月-2014年7月抽样选取200例气道分泌物较多或吸入异物的有创通气患者,随机分成治疗组(n=100)和对照组(n=100),两组患者均行纤维支气管镜清理呼吸道治疗,其中治疗组进行肺复张策略,观察两组患者治疗前、治疗后2 h氧合指数、动脉血二氧化碳分压(Pa CO2)、心率、气道阻力、肺动态顺应性(Cdyn)变化及有创通气时间和住重症监护病房(ICU)时间。结果治疗后,治疗组和对照组氧合指数分别为(291.14±38.49)、(241.39±35.62)mm Hg(1 mm Hg=0.133 k Pa),Pa CO2分别为(41.65±7.73)、(38.87±7.97)mm Hg,Cdyn分别为(48.94±11.21)、(39.59±10.98)m L/cm H2O(1 cm H2O=0.098 k Pa),均较治疗前升高(P<0.05);治疗组和对照组心率分别为(95.41±20.59)、(106.47±19.11)次/min,气道阻力分别为(17.87±8.32)、(23.98±7.88)cm H2O/(L·s),均较治疗前降低(P<0.01)。治疗组有创通气时间为(15.72±6.42)d,住ICU时间为(19.85±8.12)d,对照组有创通气时间为(20.49±7.21)d,住ICU时间为(27.87±10.33)d。与对照组治疗后比较,治疗组治疗后患者的气道阻力降低、有创通气时间和住ICU时间减少,Cdyn、氧合指数和Pa CO2均升高(P<0.01);心率改变组间差异无统计学意义(P>0.05)。结论在气道分泌物较多或吸入异物的有创通气患者中,行纤维支气管镜治疗后应用肺复张策略,使患者萎陷的肺泡能够再次复张,能显著改善患者肺通气和换气功能障碍,增加了肺的顺应性,提高肺弥散功能,从而缩短有创通气时间和住ICU时间,对患者的治疗有重要意义。
Objective To study the therapeutic effect of pulmonary reexpansion after bronchofiberscopy in patients with invasive ventilation who have more airway secretions or foreign bodies. Methods From September 2012 to July 2014, 200 patients with invasive ventilation who had more airway secretions or inhaled foreign bodies were randomly divided into treatment group (n = 100) and control group (n = 100). Two groups of patients All the patients were treated with bronchoscopy for respiratory tract resuscitation. The treatment group was given pulmonary reexpansion strategy. Before treatment, the oxygenation index, PaCO 2, heart rate, airway resistance, Dynamic compliance (Cdyn) changes and invasive ventilation time and intensive care unit (ICU) time. Results After treatment, the oxygenation index of the treatment group and the control group were (291.14 ± 38.49), (241.39 ± 35.62) mm Hg (1 mm Hg = 0.133 k Pa), Pa CO2 was (41.65 ± 7.73), (38.87 ± 7.97) mm Hg and Cdyn were (48.94 ± 11.21) and (39.59 ± 10.98) m L / cm H2O (1 cm H2O = 0.098 kPa) The heart rate was (95.41 ± 20.59) and (106.47 ± 19.11) times / min and the airway resistance was (17.87 ± 8.32) and (23.98 ± 7.88) cm H2O / (L · s) P <0.01). The duration of invasive ventilation was (15.72 ± 6.42) days in treatment group and (19.85 ± 8.12) days in ICU, and (20.49 ± 7.21) days in control group and (27.87 ± 10.33) days in ICU. Compared with the control group, the patients in the treatment group had lower airway resistance, shorter duration of invasive ventilation and ICU stay, higher Cdyn, oxygenation index and PaCO 2 (P <0.01), and heart rate difference No statistical significance (P> 0.05). Conclusions In patients with invasive ventilation who have more airway secretions or inhaled foreign bodies, pulmonary reexpansion strategy may be applied after the treatment of bronchoscopy to make the collapsed alveoli of the patient again able to significantly improve pulmonary ventilation and ventilation Dysfunction, increased lung compliance, improve lung diffusion function, thus shortening the time of invasive ventilation and ICU living in patients with treatment of great significance.