说话瓣膜联合体外膈肌起搏在ICU清醒气管切开困难脱机患者中的应用  

Application of speech valve combined with extracorporeal diaphragm pacing in ICU awake tracheotomy patients with difficult weaning

作　　者：李艳艳[1] 高志明 唐媚 郭丽[1] 钟建[1] LI Yanyan;GAO Zhiming;TANG Mei;GUO Li;ZHONG Jian(Department of Critical Medicine, Peking University Shenzhen Hospital, Shenzhen 518000,China)

机构地区：[1]北京大学深圳医院重症医学科,广东深圳518000

出　　处：《医药高职教育与现代护理》2022年第2期147-150,共4页Medical Higher Vocational Education and Modern Nursing

摘　　要：目的研究说话瓣膜联合体外膈肌起搏在重症监护室(ICU)清醒气管切开困难脱机患者中的应用效果。方法将北京大学深圳医院从2018年1月至2021年8月收治的66例ICU清醒气管切开困难脱机患者纳入研究。以电脑随机数字表法分为作联合组及常规组,每组33例。常规组予以常规脱机锻炼及体外膈肌起搏治疗,联合组则在常规组的基础上增用说话瓣膜干预。对比两组误吸、呼吸机相关性肺炎发生率以及脱机成功率,机械通气以及入住ICU时间,治疗前后呼气峰流量以及潮气量,治疗前后膈肌厚度、活动度。结果联合组误吸、呼吸机相关性肺炎发生率分别为0、0,均低于常规组的15.15%、15.15%,而脱机成功率为84.85%,高于常规组的60.61%(均P<0.05)。联合组机械通气以及入住ICU时间均少于常规组(均P<0.05)。联合组治疗后呼气峰流量以及潮气量均高于常规组(均P<0.05)。联合组治疗后膈肌厚度、活动度均高于常规组(均P<0.05)。结论说话瓣膜联合体外膈肌起搏在ICU清醒气管切开困难脱机患者中的应用效果较佳,可明显提高脱机成功率,降低并发症发生风险,促进患者康复,有助于膈肌厚度和活动度的改善。Objective To study and analyze the effect of speech valve combined with extracorporeal diaphragm pacing in patients with wakeup tracheotomy and difficult weaning in intensive care unit(ICU).Methods From January 2018 to August 2021,66 patients with difficult weaning after waking tracheotomy in ICU were included in the study.The patients were divided into the combined group and the conventional group with 33 cases in each group by computer random number table.The conventional group was given regular off-line exercise,and the combined group was given speech valve intervention on the basis of the conventional group.The incidence of aspiration,ventilators associated with pneumonia and the success rate of weaning,mechanical ventilation and ICU stay,peak expiratory flow and tidal volume before and after treatment,diaphragm thickness and activity were compared between the two groups.Results The incidence of aspiration and ventilator-associated pneumonia in the combined group was 0 and 0,respectively,lower than 15.15%and 15.15%in the conventional group,while the success rate of weaning was 84.85%,higher than 60.61%in the conventional group(all P<0.05).Mechanical ventilation and ICU stay time in the combined group were lower than those in the conventional group(all P<0.05).After treatment,peak expiratory flow and tidal volume in combined group were higher than those in the conventional group(P<0.05).After treatment,the thickness and activity of diaphragm in combined group were higher than those in the conventional group(all P<0.05).Conclusions Speaking valve combined with extracorporeal diaphragm pacing has a good effect in ICU patients with wakeup tracheotomy and difficult weaning,which can significantly improve the success rate of weaning,reduce the risk of complications,promote the rehabilitation of patients,and improve the thickness and activity of diaphragm.

关 键 词：困难脱机 说话瓣膜 体外膈肌起搏 气管切开 ICU护理 

分 类 号：R47[医药卫生—护理学]