两种气管内吸引术在颅内高压动物中的应用比较  

Comparison between two methods of endotracheal suctioning used in animals with intracranial hypertention

作　　者：郑爱茗[1] 龚孝淑[1] 顾倩[1] 

机构地区：[1]第二军医大学长征医院临床护理教研室,上海市200003

出　　处：《中华护理杂志》2003年第3期165-167,共3页Chinese Journal of Nursing

摘　　要：目的 :研究颅内高压状态下开放式气管内吸引术 (Openendotrachealsuctioning,OpenETS)与闭合式气管内吸引术 (Closedendotrachealsuctioning ,ClosedETS)对平均动脉压 (MAP)、颅内压 (ICP)、脑灌注压 (CPP)和脑氧代谢等方面的影响及其意义。方法 :实验动物随机分成OpenETS组 (n =10 )和ClosedETS组 (n =10 ) ,麻醉后行气管切开插管 ,呼吸机辅助呼吸。利用微泵注射自体血法建立兔急性脑内血肿模型 ,待ICP稳定在较高水平后 ,分别进行两种气管内吸引术。于吸引前、后动态监测MAP、ICP、CPP变化 ,同时运用颈内静脉插管技术及外周血气分析观察颈静脉氧饱和度 (SjvO2 )、脑氧摄取率 (CEO2 )、脑动静脉氧差(AVDO2 )变化。结果 :两组动物吸引后即时MAP均升高 ,OpenETS组较ClosedETS组明显 (P <0 .0 5 )。吸引后即时ICP均短暂升高 ,两组变化趋势基本相同 ,大多于 5min内回落 ,其回复较SjvO2 快。吸引后即时OpenETS组SjvO2 下降至 76 .9%± 5 .3 %(P <0 .0 1) ,CEO2 、AVDO2 明显上升 (P <0 .0 1) ,CPP下降 (P <0 .0 1) ;而ClosedETS组SjvO2 上升 (P <0 .0 5 ) ,CEO2 、AVDO2 下降(P <0 .0 5 ) ,CPP变化无统计学意义。结论 :颅内高压状态下OpenETS可引起脑缺血、缺氧反应 ,而ClosedETS不损害脑灌注并维持足够脑氧?Objective: To study the effect and significance of open endotracheal suctioning and closed endotracheal suctioning on MAP?ICP?CPP and cerebral oxygenation in animals with intracranial hypertention. Methods: The intubated and mechanically ventilated animals were randomly assigned to open ETS group(n=10) and closed ETS group(n=10).Autologous blood was injected by micropump to establish a model of intracerebral hematoma. After ICP stayed at a high level, open ETS and closed ETS were applied respectively. By using a technique of jugular catheterization and analying blood gases, the changes in SjvO 2?CEO 2 and AVDO 2 were observed, and MAP?ICP?CPP were continuously monitored before and after the procedures. Results: MAP in both groups was increased from baseline after ETS, and the increase in open ETS group was significantly more than that in closed ETS group(P<0.05).All the animals had transient elevations of ICP immediately after ETS, and there was a same trend of ICP changing in two groups. In most cases, ICP had returned to baseline within 5 minutes, which was more rapidly than SjvO 2.Immediately after ETS, SjvO 2 was greatly decreased to 76.9±5.3% (P<0.01),CEO 2 and AVDO 2 improved (P<0.01) with a concomitant decrease in CPP(P<0.01) in open ETS group, while in Closed ETS group SjvO 2 increased(P<0.05) and CEO 2 and AVDO 2 decreased(P<0.05),with no obvious changes in CPP. Conclusions: Open ETS can negatively influence cerebral oxygenation during intracranial hypertention, whereas closed ETS had no adverse effect on CPP and maintained cerebral oxygenation.Closed ETS appears to be more reasonable and should be recommended in traumatic brain-injured patients.

关 键 词：气管内吸引术 颅内高压 OpenETS ClosedETS 血气分析 动物实验 护理措施 

分 类 号：R473.6[医药卫生—护理学]