气管插管后早期胃肠减压对机械通气患者呼吸力学的影响  

The effect of early gastrointestinal decompression on the respiratory mechanics of the patients with mechanical ventilation after tracheal intubation

作　　者：任佳乐 王志伟 张伟[2] 杨建中[2] Ren Jiale;Wang Zhiwei;Zhang Wei;Yang Jianzhong(School of Nursing,Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学护理学院,新疆乌鲁木齐830000 [2]新疆医科大学第一附属医院急救中心,新疆乌鲁木齐830054

出　　处：《中国急救医学》2024年第1期88-92,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨气管插管后早期进行胃肠减压对机械通气患者呼吸力学的影响及其临床应用价值。方法本研究为前瞻性观察性研究,将新疆医科大学第一附属医院急诊抢救室2023年3月至2023年6月接受气管插管后机械通气的132例患者分为观察组(n=66)和对照组(n=66)。观察组在气管插管后的1 h内进行胃肠减压,对照组在气管插管后的6 h内未进行胃肠减压治疗。收集两组患者的一般资料,并在气管插管即刻(T0)、机械通气1 h(T1)、机械通气2 h(T2)、机械通气4 h(T3)、机械通气6 h(T4)时分别测量两组患者的呼吸力学参数、氧合及腹内压变化情况进行并分析。结果在T0时,两组的呼吸力学指标差异均无统计学意义(P>0.05),两组的气道峰压(Ppeak)均下降差异无统计学意义(P>0.05);在T3和T4时,观察组的平台压(Pplat)和平均气道压(Pmean)显著低于对照组,静态顺应性(Cstat)显著高于对照组,差异均有统计学意义(P<0.05);在T1后,观察组的PaO 2/FiO 2显著高于对照组(P<0.05);在T4时,观察组的腹内压显著低于对照组(P<0.05)。结论在气管插管后1 h内进行胃肠减压能够有效改善机械通气患者的呼吸力学指标,降低腹内压,提高肺部顺应性和氧合情况。Objective To explore the effect of early gastrointestinal decompression after tracheal intubation on the respiratory mechanics of mechanically ventilated patients and its clinical application value.Methods In this prospective observational study,132 mechanically ventilated patients who underwent tracheal intubation in emergency rescue of the First Affiliated Hospital of Xinjiang Medical University from March 2023 to June 2023 were divided into observation group(n=66)and control group(n=66).The observation group underwent gastrointestinal decompression within 1 hour after tracheal intubation,while the control group did not undergo gastrointestinal decompression 6 hours after tracheal intubation.General information was collected for both groups,and the changes in respiratory mechanics parameters,PaO 2/FiO 2,and intra-abdominal pressure(IAP)were monitored and analyzed at various time points:tracheal intubation(T0),1 hour of mechanical ventilation(T1),2 hours of mechanical ventilation(T2),4 hours of mechanical ventilation(T3),and 6 hours of mechanical ventilation(T4).Results At T0,there were no statistically significant differences in respiratory mechanics between the two groups(P>0.05);The peak airway pressure(Ppeak)decreased in both groups,but there was no statistically significant difference(P>0.05);At T3 and T4,the plateau pressure(Pplat)and mean airway pressure(Pmean)were significantly lower and the static lung compliance(Cstat)was significantly higher in the observation group compared to the control group(P<0.05);After T1,the PaO 2/FiO 2 of the observation group was significantly higher than that of the control group;At T4,the IAP of the observation group was significantly lower than that of the control group(P<0.05).Conclusions The gastrointestinal decompression within 1 hour after tracheal intubation is an effective method to improve respiratory mechanics,reduce IAP,and improve lung compliance and oxygenation for mechanically ventilated patients.

关 键 词：气管插管 早期胃肠减压 平台压 平均气道压 气道峰压 静态顺应性 腹内压 氧合 

分 类 号：R459.7[医药卫生—急诊医学]