说话瓣膜在机械通气脱机困难患者中的应用  

EFFECT OF USING THE TALKING VALVE ON PATIENTS WITH MECHANICAL VENTILATION DIFFICULTY OFFLINE

作　　者：吴萌萌 孙雪梅[1] 信淑珍[1] 刘新平[1] 王伯丽 高健 马静 吴艳军 张青芸 李义靖 Wu Mengmeng;Sun Xuemei;Xin Shuzhen(Binzhou People’s Hospital,Binzhou 256610,China)

机构地区：[1]山东第一医科大学附属滨州市人民医院,山东省滨州市256610 [2]河北医科大学第二医院 [3]唐山市人民医院

出　　处：《中国煤炭工业医学杂志》2020年第5期510-514,共5页Chinese Journal of Coal Industry Medicine

基　　金：河北省医学科学研究课题计划(编号:20191609)。

摘　　要：目的探讨说话瓣膜在机械通气气管切开后脱机困难患者中的应用效果。方法选取2016年3月—2020年4月滨州市人民医院ICU收治的气管切开困难脱机患者78例,随机分为观察组和对照组(观察组40例,对照组38例),二组都按照常规的脱机方式进行脱机锻炼,在此基础上,观察组加用说话瓣膜进行脱机锻炼。对二组患者的机械通气时间、入住ICU时间、呼吸机相关性肺炎发生率、脱机成功率、膈肌厚度和活动度及最大吸气压(MIP)等方面进行比较。结果对于传统的脱机锻炼方式而言,应用说话瓣膜的观察组机械通气时间及入住ICU时间均较对照组明显缩短(P <0.05)。观察组脱机成功率高于对照组(85.0%>60.6%,P<0.05)。观察组呼吸机相关性肺炎发生率低于对照组(15.00%<38.64%,P<0.05)。治疗两周后,二组患者膈肌厚度、活动度和MIP比较,观察组优于对照组[膈肌厚度(0.22±0.01)cm>(0.19±0.03)cm,活动度(4.41±1.04)cm>(3.11±0.91)cm,MIP(18.91±2.04)cmH2O>(16.90±2.09)cmH2O,P<0.05]。结论对于传统的脱机锻炼方式而言,给予患者佩戴说话瓣膜的方式使患者应用呼吸机时间和入住ICU时间明显缩短,且呼吸机相关性肺炎等并发症发生率降低。对于ICU困难脱机的患者,说话瓣膜的使用值得推广。Objective To investigate the effect of speech valve in patients with weaning difficulties after mechanical ventilation tracheotomy.Methods Seventy eight patients with tracheotomy difficulty were randomly divided into observation group and control group(40 cases in observation group and 38 cases in control group) from March 2016 to April 2020 ICU Binzhou People′s Hospital.On this basis,the observation group added speaking valve for offline exercise.Compare the mechanical ventilation time,occupancy ICU time,incidence of ventilator-associated pneumonia,success rate of weaning,diaphragm thickness,activity and maximum inspiratory capacity between the two groups.Results For the traditional offline practice,the mechanical ventilation time and occupancy ICU time in the observation group were significantly shorter than those in the control group(P<0.05).Access rate of the observation group was higher than the control group(85.0%>60.6%,P<0.05).Incidence of ventilator-associated pneumonia of the observation group was lower than the control group(15.00 %<38.64%,P<0.05).After two weeks of treatment,comparison of diaphragm thickness,activity and MIP between the two groups,the observation group was better than the control group[diaphragm thickness(0.22±0.01) cm>(0.19±0.03) cm,activity(4.41±1.04) cm>(3.11±0.91) cm,MIP(18.91±2.04) cmH2O>(16.90±2.09) cmH2O,P<0.05].Conclusion For the traditional off-line exercise,the time of using ventilator and the time of staying in the ICU were shortened,and complications such as ventilator-associated pneumonia occurred,the rate is lower.For patients with ICU difficulty offline,the use of speech valves is worth popularizing.

关 键 词：气管切开术 呼吸机脱机困难 说话瓣膜 

分 类 号：R459.7[医药卫生—急诊医学]