机械性吸-呼气排痰技术联合体外膈肌起搏技术在高龄老年机械通气患者中的应用  

Application of mechanical insufflation-exsufflation combined with external diaphragm pacemaker in elderly patients with mechanical ventilation

作　　者：赵静[1] 侯惠如[2] 张智健[1] 来纯云[1] 武淑萍[1] 王娟丽[3] Zhao Jing;Hou Huiru;Zhang Zhijian;Lai Chunyun;Wu Shuping;Wang Juanli(Department of Respiratory and Critical Care Medicine,the Second Medical Center of PLA General Hospital,Beijing 100853,China;Nursing Department,the Second Medical Center of PLA General Hospital,Beijing 100853,China;the Ninth Department of Health Care and Medicine,the Second Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心呼吸与危重症医学科,北京100853 [2]解放军总医院第二医学中心护理部,北京100853 [3]解放军总医院第二医学中心保健九科,北京100853

出　　处：《中华现代护理杂志》2020年第30期4156-4160,共5页Chinese Journal of Modern Nursing

基　　金：北京市科技重大专项;生物医药与生命科学创新培育研究(Z171100000417032);国家老年疾病临床医学研究中心开放课题(NCRCG-PLAGH-2017013);军队保健专项科研基金(19BJZ32)。

摘　　要：目的:探讨机械性吸-呼气排痰联合体外膈肌起搏技术在高龄老年人群应用的适宜性及其对机械通气并发症及预后的影响。方法:采用便利抽样法,选取解放军总医院老年病房2018年9月—2019年12月收治的高龄老年行经鼻气管插管机械通气的40例患者作为研究对象,采用随机数表法分为观察组和对照组,每组各20例。对照组延续传统的气道护理技术和肢体康复训练,观察组在对照组基础之上加用机械性吸-呼气排痰技术和体外膈肌起搏技术。观察两组患者干预前后肺部感染发生率、1 h和24 h排痰量变化、膈肌增厚率、撤机时间以及撤机成功率和病死率。结果:干预后观察组肺部感染发生率低于对照组,1 h和24 h排痰量、膈肌增厚率高于对照组,撤机时间短于对照组,撤机成功率高于对照组,差异均有统计学意义(P<0.05);两组患者的病死率差异无统计学意义(P>0.05)。结论:机械性吸-呼气排痰联合体外膈肌起搏技术与传统的气道护理技术相比,能够帮助高龄老年机械通气患者更加安全有效地实现气道廓清和呼吸肌锻炼目的,提高膈肌的肌力和耐力,增强高龄老年患者自主咳嗽能力;且干预方式温和,患者易于接受,值得在高龄老年机械通气患者中广泛应用。Objective To explore the suitability of mechanical insufflation-exsufflation combined with external diaphragm pacemaker in elderly patients with mechanical ventilation and its effect on the complications and prognosis of mechanical ventilation.Methods Using the convenient sampling method,a total of 40 elderly patients undergoing mechanical ventilation through nasal tracheal intubation who were admitted to the Geriatric Ward of the PLA General Hospital from September 2018 to December 2019 were selected as the research objects.The patients were divided into the observation group and the control group by random number table method,with 20 cases in each group.The control group continued the traditional airway nursing technique and limb rehabilitation training,while the observation group added mechanical insufflation-exsufflation combined with external diaphragm pacemaker on the basis of the control group.The incidence of pulmonary infection,changes in sputum production at 1 h and 24 h,diaphragm thickening rate,weaning time,success rate of weaning and mortality rate were observed in the two groups before and after intervention.Results After the intervention,the incidence of pulmonary infection in the observation group was lower than that of the control group,the sputum production and diaphragm thickening rate at 1 h and 24 h were higher than those in the control group,the weaning time was shorter than that of the control group,and the success rate of weaning was higher than that of the control group.All differences were statistically significant(P<0.05).There was no statistically significant difference in mortality rate between the two groups(P>0.05).Conclusions Compared with traditional airway nursing techniques,mechanical insufflation-exsufflation combined with external diaphragm pacemaker can help elderly patients with mechanical ventilation achieve airway clearance and respiratory muscle exercise more safely and effectively,improve strength and endurance of diaphragmatic muscle and enhance the ability of spontaneo

关 键 词：老年人 机械通气 机械性吸-呼气排痰技术 体外膈肌起搏 

分 类 号：R472[医药卫生—护理学]