不同吸痰深度对重型颅脑损伤术后患者高原Lundberg—A波和B波的影响  

Impact of endotracheal suctioning depth on the plateau wave A ＆ B with severe traumatic brain injuries receiving mechanical ventilation

作　　者：陶文强[1] 石尧[2] 方海云[3] 李薇薇[2] 李尹凤[3] 

机构地区：[1]广州中医药大学第二临床医学院3年制博士班,广东广州510405 [2]广东省中医院神经三科NICU,广东广州510120 [3]广州中医药大学附属北碚中医院ICU,重庆北碚410007

出　　处：《中国急救医学》2014年第5期404-407,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨吸痰深度对重型颅脑损伤（sTBI）术后患者颅内压（ICP）、高原Lundberg—A波、B波和呼吸机相关性肺炎（VAP）发生率的影响。方法75例行ICP监测和人工气道开放的重型颅脑损伤术后患者，随机分为浅部吸痰（组I）、深部吸痰（组Ⅱ）和改良深部吸痰（组111），每组各25例。记录术后3d每天4个时点吸痰前后ICP数值变化、5d内高原Lundberg—A和B波发生次数及其前后ICP数值变化和7d内VAP发生率。结果组I对ICP影响最小，Lundberg—A波频次最低，VAP发生率58．33％；组Ⅱ对ICP影响最大，Lundberg—A波发生频次最高，VAP发生率26．09％；组Ⅲ对ICP影响居中，Lundberg—A波发生频次居中，VAP发生率29．17％。未证实吸痰与Lundberg—B波发生有关。结论改良吸痰方式相对减少了sTBI患者术后Lundberg—A波和VAP发生率，有益于病情。Objeetlve To investigate the impact of different endotracheal suctioning depth on the intracranial pressure （ICP） and plateau wave Lundberg - A＆B and incidence of ventilator associated pneuminia （VAP） in patients with severe traumatic brain injuries （sTBI） receiving mechanical ventilation. Methods Seventy -five patients with mechanical ventilation in the neurosurgieal ICU were divided into shallow suctioning group, deep suctioning group and modified deep suctioning group. The change of ICP before and after suetioning at time of 3, 9, 15 and 21 o ＂clock within three days, frequency of Lundberg - A＆B within five days, and the incidence of VAP within seven days during mechanical ventilation were compared. Results In shallow suctioning group, the ICP during suctioning was the most stable, and the frequency of Lundberg - A was the least, and the incidence of VAP was 58.33%. In deep suctioning group, the ICP increased the most during the suctioning and the frequency of Lundberg- A was the most, and the incidence of VAP was 26.09%. In modified deep suctioning group, the ICP increased at the middle during the suctioning and also at the frequency of Lundberg - A and the incidence of VAP was 29. 17%. When the Lundberg A occurred the ICP was higher than common. Not confirmed sputum suction related to B wave occurred. Conclusion The modified deep suctioning is proved to be a safer and more effective method for patients with sTBI.

关 键 词：颅脑损伤 颅内压(ICP) 高原波 痰 呼吸机相关性肺炎(VAP) 

分 类 号：R651.15[医药卫生—外科学]