预见性气道局麻后吸痰对重型颅脑损伤术后患者高原波的影响  

Impact of advanced local anesthesia in endotracheal on the plateau wave A ＆amp; 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]重庆市中医院神经内科陶文强,重庆江北402760 [2]广东省中医院神经三科NICU,广东广州510405 [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》2015年第8期702-705,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的：探讨重型颅脑损伤（ sTBI）术后患者预见性使用利多卡因气道给药后吸痰对颅内压（ ICP）、高原波Lundberg－A波和B波、呼吸机相关性肺炎（ VAP）的影响。方法50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治疗组和对照组，每组各25例。治疗组在吸痰前ICP≥20 mm Hg，则预见性使用利多卡因气道麻醉，ICP＜20 mm Hg时与对照组一样均行常规吸痰。记录术后5 d吸痰前后每天4个时点ICP变化、Lundberg－A和B波发生频次及其吸痰前后ICP变化和7 d内VAP发生率。结果两组常规吸痰ICP均升高。治疗组预见性气道局麻后吸痰，Lundberg－A波频次低，峰值低，VAP发生率26．09％；对照组Lundberg－A波频次高，峰值高，VAP发生率29．17％；未证实气道麻醉吸痰与否和Lundberg－B波形成有关。结论预见性利多卡因气道给药后吸痰，能提高sTBI患者术后Lundberg－A波发生阈值，降低频次及峰值。Objective To investigate the impact of advanced local anesthesia on the intracranial pressure （ ICP） and plateau wave Lundberg -A＆B and incidence of ventilator associated pneumonia （VAP） in patients with severe traumatic brain injuries （ sTBI） receiving mechanical ventilation. Methods Fifty patients with mechanical ventilation in the neurosurgical ICU were divided into treatment group and control group （n=25）.When the ICP was at 20-25 mm Hg before suctioning, the treatment group received local anesthesia in endotracheal with lidocaine ultrasonic aerosol inhalation.The change of ICP before and after suctioning at time of 3, 9, 15 and 21 o＇clock within five days, frequency of Lundberg-A＆amp;B within five days, and the incidence of VAP within seven days during mechanical ventilation were compared.Results In treatment group, the ICP during suctioning was the more stable and the frequency of Lundberg-A was less than the control group.The incidence of VAP was 29.17%in treatment group and 26.09%in control group.The ICP increased more during the suctioning and the frequency of Lundberg-A was the most, and the incidence of VAP was 26.09% in the control group. When the Lundberg-A occurred, the ICP in treatment group was more lower than the other.Whether sputum suction correlates to the occurrence of B wave has not been confirmed in the present study. 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 利多卡因 痰 呼吸机相关性肺炎(VAP) 

分 类 号：R651.15[医药卫生—外科学]