经鼻气管内吸引在无创正压通气患者气道管理中的应用  

Application of Nasotracheal Suction in Airway Management of Patients during Noninvasive Positive Pressure Ventilation

作　　者：曹玉书[1] 官正标[1] 赵红霞[1] 董洁[1] 

机构地区：[1]解放军411医院呼吸科,上海200081

出　　处：《中国呼吸与危重监护杂志》2013年第6期572-575,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的观察经鼻气管内吸引(NTS)在排痰障碍的无创正压通气(NPPV)患者气道管理中的应用效果。方法临床有气管内分泌物潴留和急性低氧血症的NPPV患者,经常规口咽部吸痰和胸部物理治疗无效者,随机分为试验组(21例)和对照组(15例)。试验组NPPV联合NTS和胸部物理治疗;对照组终止NPPV后给予有创机械通气。观察试验组NTS治疗前后临床症状、体征、氧饱和度、心电监测和通气参数的变化,以及试验组和对照组患者的临床转归。结果试验组均成功气管内置入吸痰管,NTS操作平均(33±0.9)次;首次NTS后呼吸困难和低氧血症改善(20/21,占952%),主要不良反应为一过性加重的低氧血症(14/21,占667%)、一过性心电监测异常(4/21,占189%)。试验组NTS有效且临床治疗成功16例,成功率为762%,治疗不成功而转为有创通气者5例,治疗成功2例,死亡3例,平均住院时间(173±74)d;对照组无创通气转为有创通气15例,治疗成功l1例,成功率733%,死亡4例,平均住院时间(145±57)d。两组间各项指标比较均无显著性差异(P>0.05)。结论 NPPV患者出现排痰障碍时,通过NTS可清除气道内分泌物,维持NPPV的有效治疗,减少有创通气使用。Objective To explore the effect of nasotracheal suction （ NTS） in airway managementof patients with expectoration inability during noninvasive positive pressure ventilation （ NPPV） .？Methods 36 cases with airway secretions retention and acute hypoxemia during NPPV were randomly divided into twogroups when regular suction and chest physiotherapy was invalid. An experimental group （ n = 21） weretreated by NPPV combined with NTS and a control group （ n = 15） by invasive mechanical ventilation asNPPV terminated. The symptoms and signs, ECG monitoring, oxygenation, ventilation parameters before andafter NTS, as well as the clinical outcomes in two groups were recorded.？Results The sputum aspiratorpipes could be inserted into trachea successfully during NTS procedures with average times of 3. 3 ±0. 9 inthe experimental group. Dyspnea and hypoxemia improved after the first NTS in 20/21 （ 95. 2% ） of theexperimental group. The main adverse reactions were transient aggravating hypoxemia（ 14 /21, 66. 7% ） andarrhythmias （ 4/21,18. 9% ） but no more severe complications occurred. 16 /21 （ 76. 2%） were cured whileother 5 cases were switched to invasive mechanical ventilation in the experimental group, and 11 /15（ 73. 3% , P 〉0. 05） were cured in the control group. For the experimental group and the control group theduration of hospitalization was （ 17. 3 ±7. 4） vs. （ 14. 5 ±5. 7） days （ P 〉 0. 05） and the number of deathwas 3 /21 vs. 4/15 （ P 〉 0. 05） , respectively.？Conclusion As removing the airway secretions effectivelywith mild complications, NTS ensures the efficacy of NPPV treatment and reduces the probability of invasiveventilation.

关 键 词：经鼻气管内吸引 无创正压通气 气道管理 

分 类 号：R56[医药卫生—呼吸系统]