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目的评价自制口鼻面罩下无创正压通气辅助支气管镜吸痰的应用效果。方法选择2011年10月-2012年10月我院呼吸科监护病房使用无创机械通气排痰困难患者33例,随机分为口鼻面罩组15例和对照组18例。口鼻面罩组采用经自制口鼻面罩下无创正压通气辅助支气管镜吸痰;对照组采取传统吸痰方式,即直接摘下面罩吸痰。记录两组患者在吸痰前、进镜过程中、吸痰中、吸痰结束时、吸痰结束后10 min的心率、呼吸频率、平均血压、脉氧饱和度。同时在吸痰前和吸痰结束时检测患者动脉血气水平。结果两组性别、年龄、急性生理学及慢性健康状况(APACHEⅡ)评分比较差异无统计学意义(P>0.05)。口鼻面罩组在吸痰过程中各个时间点心率和呼吸频率始终低于对照组,脉氧饱和度始终高于对照组(P<0.05)。吸痰结束时,口鼻面罩组的pH、PaO2明显高于对照组,PaCO2明显低于对照组(P<0.05)。结论经自制的改良口鼻面罩下无创正压通气辅助支气管镜吸痰能够使患者呼吸频率、脉氧饱和度和动脉血气保持在一个较为稳定的水平,安全性高、应用价值大。
Objective To evaluate the application of noninvasive positive pressure ventilation assisted bronchoscopy suctioning under homemade mask. Methods From October 2011 to October 2012, 33 cases of patients with non-invasive mechanical ventilation and sputum aspiration in our department’s respiratory department were randomly divided into oral masseter group (n = 15) and control group (n = 18). Oral and nasal masks group made by self-made non-invasive positive pressure nasal mask nasal suction bronchoscopy suction; control group to take the traditional suction method, that is, directly removed the mask suction sputum. The heart rate, respiratory rate, mean blood pressure and pulse oximetry were recorded before sputum aspiration, aspiration, aspiration, aspiration, 10 min after aspiration. Patients were also tested for arterial blood gas levels before aspiration and aspiration. Results There was no significant difference in gender, age, acute physiology and chronic health status (APACHE II) between the two groups (P> 0.05). Oral and nasal masks group in the suctioning process at various time points heart rate and respiratory rate is always lower than the control group, oxygen saturation is always higher than the control group (P <0.05). At the end of sputum aspiration, the pH and PaO2 of the mask group were significantly higher than those of the control group, and PaCO2 was significantly lower than that of the control group (P <0.05). Conclusion Self-made modified nasal mask under noninvasive positive pressure ventilation assisted bronchoscopy sputum suction can make the patient’s respiratory rate, arterial oxygen saturation and arterial blood gas at a relatively stable level, high safety and great value.