不同痰栓处理方案在ICU人工气道患者中的应用对比  

Comparison of different sputum clot treatment schemes in ICU patients with artificial airway

作　　者：葛文明 秦超[1] 伍静[1] 王振军[1] 高康 罗坤[1] 韩云鹏 Ge Wenming;Qin Chao;Wu Jing;Wang Zhenjun;Gao Kang;Luo Kun;Han Yunpeng(Department of Acute and Critical Care Medicine,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第五附属医院急重症医学部,郑州450000

出　　处：《中国实用医刊》2025年第2期31-35,共5页Chinese Journal of Practical Medicine

基　　金：2023年河南省医学科技攻关计划项目(LHGJ20230399)。

摘　　要：目的比较不同痰栓处理方案(开放式改良吸痰、纤支镜肺泡灌洗)在重症监护病房(ICU)人工气道患者中的应用效果。方法前瞻性研究。抽取2020年8月至2023年9月于郑州大学第五附属医院ICU建立人工气道患者92例,按照随机数字表法将其分为开放组(46例,予以开放式改良吸痰)和纤支镜组(46例,予以纤维支气管镜肺泡灌洗)。记录并比较两组吸痰相关指标、气道处理后各时间点(24、48、72 h)痰液黏稠度及痰痂形成情况、血气指标[血氧饱和度(SaO 2)、氧合指数(OI)]及不良事件发生率。结果气道处理第3天,纤支镜组每日吸痰次数少于开放组(P<0.05),吸痰间隔时间长于开放组(P<0.05)。气道处理后24、48、72 h,纤支镜组痰液黏稠度(Ⅲ度)占比低于开放组(P<0.05)。纤支镜组气道处理后痰痂再形成率低于开放组(P<0.05)。气道处理后1 min,纤支镜组SaO 2、OI水平高于开放组(P<0.05)。纤支镜组不良事件发生率(6.52%,3/46)与开放组(19.56%,9/46)比较,差异未见统计学意义(P>0.05)。结论相较开放式改良吸痰,纤维支气管镜肺泡灌洗能更彻底地清除ICU人工气道患者气道分泌物和痰栓,提高OI。Objective To compare the application effects of different sputum clot treatment schemes(open modified sputum suction method,bronchoscopic bronchoalveolar lavage)on intensive care unit(ICU)patients with artificial airway.Methods Ninety-two patients with artificial airways admitted to the ICU of the Fifth Affiliated Hospital of Zhengzhou University from August 2020 to September 2023 were selected prospectively.And they were divided into the open group(46 cases,treated by open modified suction)and the bronchoscopy group(46 cases,treated by bronchoscopic bronchoalveolar lavage)using a random number table method.The sputum suction-related indexes,sputum viscosity and sputum crust formation at each time point(24,48,and 72 hours after airway treatment),blood gas indexes such as oxygen saturation(SaO 2)and oxygenation index(OI),and the incidence of adverse events were recorded and compared between the two groups.ResultsOn the third day of airway management,the number of daily suctions in the bronchoscopy group was less than that in the open group(P<0.05),and the interval between suctions in the bronchoscopy group was longer than that in the open group(P<0.05).At 24,48,and 72 hours after airway treatment,the proportions of sputum viscosity(grateⅢ)in the bronchoscopy group were lower than those in the open group(P<0.05).The sputum crust reformation rate in the bronchoscopy group was lower than that in the open group(P<0.05).At 1 minute after airway treatment,the levels of SaO 2 and OI in the bronchoscopy group were higher than those in the open group(P<0.05).There was no significant difference in the incidence of adverse events between the bronchoscopy group(6.52%,3/46)and the open group(19.56%,9/46),P>0.05.Conclusions Compared with open modified sputum suction,bronchoscopic bronchoalveolar lavage can more thoroughly remove airway secretions and sputum plugs in patients with artificial airways in the ICU,and improve the OI.

关 键 词：氧合指数 痰栓 人工气道 开放式改良吸痰 纤支镜肺泡灌洗 痰液黏稠度 

分 类 号：R47[医药卫生—护理学]