两种吸痰深度对急性呼吸窘迫综合征患者血流动力学的影响  

Effects of deep and shallow endotracheal suctioning on hemodynamics in patients with acute respiratory distress syndrome

作　　者：谭华[1] 黄霞[2] 崔玉静[2] 张巧妮[2] 程青虹[2] 

机构地区：[1]新疆生产建设兵团农六师疾病预防控制中心,新疆五家渠831300 [2]新疆石河子市石河子大学医学院第一附属医院ICU,新疆石河子832008

出　　处：《中国中西医结合急救杂志》2010年第5期305-307,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的 对比分析两种吸痰深度对急性呼吸窘迫综合征（ARDS）患者血流动力学的影响,探讨ARDS患者安全有效的吸痰深度.方法 将2008年3月至2009年10月石河子大学医学院第一附属医院重症监护病房（ICU）收治的41例行机械通气的ARDS成人患者作为研究对象,通气时间均〉24 h,按随机数字表法将患者分为两组.浅吸组（20例）：吸痰管超过气管套管头端2 cm;深吸组（21例）：吸痰管深入气道遇阻力后上提2 cm.分别于吸痰前1 min及吸痰后1、5、10 min记录患者心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）的变化.结果 与吸痰前比较,两组患者吸痰后1 min HR、SBP、DBP、MAP均明显升高,且深吸组HR、SBP的增幅均高于浅吸组（均P〈0.05）;至吸痰后10 min时两组患者SBP、DBP、MAP虽有一定程度回落,但与吸痰前比较差异无统计学意义（均P〉0.05）,仅HR与吸痰前比较差异有统计学意义（均P〈0.05）.结论 浅部吸痰对患者血流动力学的影响较小,而深部吸痰会引起ARDS患者HR、血压大幅度增高,增加了心律失常、肺部损伤等风险,因此对于行机械通气治疗的ARDS患者深部吸痰应慎用.Objective To compare the hemodynamic efficacy of deep versus shallow suctioning of the endotracheal tube in patients with acute respiratory distress syndrome （ARDS） and to explore a safer and effective depth of suction for ventilated patients. Methods A prospective randomized controlled trial was conducted in the intensive care unit （ICU） of the First Affiliated Hospital of Medical Collage of Shihezi University. From March 2008 to October 2009, 41 adult cases of ARDS with mechanical ventilation （MV） for over 24 hours were enrolled and randomly divided into two groups, shallow endotracheal suctioning group （n= 20） ： the suctioning catheter was inserted and passed into the endotracheal tube and stopped ahead of its tip, but did not extend beyond the length of the tube more than 2 cm; deep endotracheal suctioning group （n=21）： the catheter was passed into the endotracheal tube until resistance was met and then retracted 2 cm before suctioning. One minute before and 1, 5, 10 minutes after endotracheal suctioning, the changes of heart rate （HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean arterial pressure （MAP） were measured. Results Compare with the data before endotracheal suctioning, both of the routine deep endotracheal suctioning group and the minimally invasive airway suctioning group （of shallow group） had significant increase of HR, SBP, DBP and MAP at 1 minute after endotracheal suctioning （all P〈0.05）. Furthermore, the amplitudes of increase in HR and SBP in deep suction group were higher than those in the shallow group （both P〈0.05）. SBP, DBP, MAP of the two groups dropped to a certain extent at 10 minutes after suctioning, but compared with the baseline, there were no significant differences （all P〉0. 05）, and only statistical significant difference in HR was obtained （both P〈0.05）. Conclusion The effects of shallow suctioning on hemodynamics in patients with ARDS are relatively mild, while the deep suctioning may

关 键 词：吸痰深度 急性呼吸窘迫综合征 血流动力学 

分 类 号：R256.1[医药卫生—中医内科学] R563.8[医药卫生—中医学]