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目的:观察危重患者吸痰前气管导管内滴注生理盐水对组织氧代谢的危害。方法:接受冠状动脉旁路移植术后入住心血管重症监护病房42例,年龄35~76岁,男26例,女16例。38例(90.5%)为首次行冠状动脉旁路移植术,4例(9.5%)为再次行冠状动脉旁路移植术。患者血流动力学状态稳定,心率60~120/min,平均动脉压60~110 mm Hg,混合静脉血氧饱和度(Sv O2)50%以上;经口建立人工气道气管插管(导管内径7.0~8.0 mm)。患者分为滴注生理盐水(NS)组18例,未滴注生理盐水组(non-NS)24例。结果:变量是混合静脉血氧饱和度基线,因变量是Sv O2最低点。协方差分析统计结果F=8.460,df=1.320,P=0.007,NS组患者Sv O2最低点明显低于non-NS组。NS组患者降低幅度-3%~-24%,Sv O2最低36%。non-NS组降低幅度0~-17%,Sv O2最低为48%。两组间恢复基线时间用不等变量t检验,t=2.079;df=18.709;P=0.050。NS组患者Sv O2恢复基线时间明显慢于Non-NS组,平均延长3.8 min。结论:危重患者吸痰操作,吸痰前不滴注NS患者的氧代谢状态较滴注NS患者效果好。
OBJECTIVE: To observe the damage of tissue oxygen metabolism caused by instillation of saline into the tracheal catheter in critically ill patients before aspiration. Methods: Forty-two patients admitted to the cardiovascular intensive care unit after coronary artery bypass grafting, aged 35-76 years, 26 males and 16 females. Thirty-eight patients (90.5%) underwent coronary artery bypass grafting for the first time and four patients (9.5%) underwent coronary artery bypass grafting again. The patient’s hemodynamics were stable with a heart rate of 60-120 / min, mean arterial pressure of 60-110 mm Hg, and mixed venous oxygen saturation (Sv O2) of 50% or more. Oral tracheal intubation 7.0 ~ 8.0 mm). The patients were divided into saline instillation group (NS), 18 cases, non-drip NS group (non-NS) in 24 cases. Results: The variables were baseline mixed venous oxygen saturation and dependent variable was the lowest point of Sv O2. Covariance analysis of statistical results F = 8.460, df = 1.320, P = 0.007, NS patients Sv O2 was significantly lower than non-NS group. NS patients decreased by -3% ~ -24%, Sv O2 minimum 36%. Non-NS group decreased by 0 ~ -17%, Sv O2 minimum of 48%. The baseline recovery time between two groups was measured by the variable t-test, t = 2.079; df = 18.709; P = 0.050. The baseline recovery time of Sv O2 in NS group was significantly slower than that in Non-NS group, with an average extension of 3.8 min. Conclusion: In patients with critically ill patients with sputum aspiration, the state of oxygen metabolism in patients without NS before aspiration is better than that in patients with NS.