吸痰深度对重型颅脑损伤患者血流动力学影响  

Effect of sputum aspiration depth on hemodynamics in patients with severe craniocerebral injury

作　　者：丁子文[1] 汤蓓[1] DING Ziwen;TANG Bei(Department of Intensive Care Unit, Jiande First People's Hospital in Zhejiang Province, Jiande 311600,China)

机构地区：[1]浙江省建德市第一人民医院重症监护室,浙江建德311600

出　　处：《中国现代医生》2017年第31期132-136,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2014ZDA019)

摘　　要：目的研究不同吸痰深度对重型颅脑损伤患者血流动力学及血氧代谢改善变化情况。方法选取2014年1月~2016年1月在本院确诊并接受气管切开治疗的重型颅脑损伤患者共130例,监测咳嗽能力不同的患者在不同吸痰深度下吸痰前后HR、MAP、SPO_2、和RSO_2四个指标的实时数据,并且在体位转换过程中监测主要包括血流动力学参数、脑组织氧分压、脑组织血氧饱和度等等比较两组的结果。结果深部吸痰组:HR和MAP水平在T_2、T_3、T_4均高于T_1水平,差异有统计学意义(P<0.05);SPO_2水平在T_2时低于T_1,T_4、T_5、T_6时高于T_1,差异有统计学意义(P<0.05);RSO_2水平在T_2、T_3、T_4、T_5、T_6时均高于T_1。浅部吸痰组:HR和MAP水平在T_2、T_3均较T_1高,差异有统计学意义(P<0.05);SPO_2水平在T_2时低于T_1,T_5、T_6高于T_1,差异有统计学意义(P<0.05);RSO_2水平在T_2、T_3、T_4、T_5、T_6时均高于T_1,差异有统计学意义(P<0.05)。结论多护理模式监护下不同吸痰深度对SBI患者的血流动力学有显著的影响,对于咳嗽能力好的患者,建议选择浅部吸痰;对于咳嗽能力差的患者,深部吸痰在RSO_2和SPO_2的改善情况更好,因此建议选择深部吸痰。Objective To study the effect of different sputum aspiration depth on the changes of hemodynamics and blood oxygen metabolism in patients with severe craniocerebral injury.Methods A total of130patients with severe craniocerebral injury diagnosed and treated with tracheotomy in our hospital from January2014to January2016were enrolled in this study.The real-time data of HR MAP,SPO2and RSO2were monitored before and after sputum aspiration with different sputum aspiration depth in patients with different cough abilities.The hemodynamic parameters,oxygen partial pressure of brain tissue,oxygen saturation of brain tissue in the body position conversion process were observed,and the results between the two groups were compared.Results In deep suction group,the levels of HR and MAP in T2,T3and T4were higher than those in T1,and the difference was significant(P<0.05).The level of SPO2in T2was lower than that in T1,and the level of SPO2in T4,T5and T6was higher than that in T1,and the difference was significant(P<0.05).The level of RSO2was higher in T2,T3,T4,T5and T6than that in T1.In shallow suction group,the levels of HR and MAP were higher in T2and T3than those in T1,and the difference was significant(P<0.05).The level of RSO2in T2was lower than that in T1,and the level of RSO2in T5,T6was higher than that in T1,and the difference was significant(P<0.05).The level of RSO2in T2,T3,T4,T5and T6was significantly higher than that in T1,and the difference was statistically significant(P<0.05).Conclusion Different depth of sputum aspiration has a significant effect on hemodynamics in patients with SBI under the supervision of multiple nursing modes.For patients with good cough ability,the shallow suction is recommended.And for poor cough patients,deep suction breaths improves RSO2and SPO2better,so deep suction is recommended.

关 键 词：重型颅脑损伤 吸痰深度 血流动力学 血氧代谢 

分 类 号：R473.5[医药卫生—护理学]