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目的:探讨密闭式吸痰时高氧疗和/或肺泡复张术对急性呼吸窘迫综合征(ARDS)患者吸痰后的应用和影响。方法:建立人工气道行机械通气的ARDS患者42例,随机分为研究组和对照组各21例,对照组采用高氧法密闭式吸痰即吸痰时高氧供吸痰前1 min给予100%氧供并贯穿整个吸痰过程共持续2 min(高氧法);研究组采用高氧-复张法(结合法)即采用高氧法与复张法密闭式吸痰方法吸痰,复张法即吸痰后即刻调节PEEP水平到2.0 kPa(20 cm H2O),通气10 s。观察吸痰前1 min、吸痰后1、3 min患者呼吸力学及血气的变化,并记录两组患者的机械通气时间、气压伤、肺不张和肺部感染的发生率。结果:两组患者吸痰前血流动力学、动脉血气、呼吸力学各参数比较,均无显著性差异(P>0.05),吸痰后除心率变化无显著性差异外(P>0.05),其余各项指标、两组机械通气时间、肺不张和肺部感染发生率差异均有显著性(P<0.05)。高氧法吸痰后1 min PaO2、SaO2较基线水平有所升高,结合法吸痰后3 min PaO2、SaO2升高(P<0.05)。结论:高氧法可短暂改善密闭式吸痰所引起的缺氧,对ARDS机械通气患者给予结合法吸痰能够保持吸痰前后全过程较好氧合状态,纠正吸痰所导致的低氧,改善肺的顺应性,并能缩短机械通气时间、降低肺不张和肺部感染发生率。
Objective: To investigate the application and effect of hyperoxia therapy and / or alveolar remodeling after aspiration on sputum aspiration in patients with acute respiratory distress syndrome (ARDS). Methods: Forty-two ARDS patients with artificial airway mechanical ventilation were established and randomly divided into study group and control group with 21 cases in each group. The control group was treated with hyperoxia closed suction sputum Oxygen supply and throughout the suction process lasted 2min (hyperoxia); study group using high oxygen - recanalization (combination method) that is the use of high oxygen method and recovery method closed suction suction sputum, complex Zhang method that immediately after sputum PEEP level adjustment to 2.0 kPa (20 cm H2O), ventilation 10 s. The changes of respiratory mechanics and blood gas were observed 1 min before sputum aspiration and 1,3 min after sputum aspiration. The duration of mechanical ventilation, pressure injury, atelectasis and pulmonary infection were recorded. Results: There was no significant difference in hemodynamics, arterial blood gas and respiration mechanics between the two groups before and after sputum aspiration (P> 0.05). There was no significant difference except heart rate after sputum aspiration (P> 0.05) The remaining indicators, the two groups of mechanical ventilation time, atelectasis and incidence of pulmonary infection were significantly different (P <0.05). PaO2 and SaO2 at 1 min after hyperoxia aspiration increased from baseline, PaO2 and SaO2 increased 3 min after sputum aspiration (P <0.05). Conclusion: Hyperbaric oxygenation can shorten the hypoxia caused by closed suction, and the combination of suctioning in patients with ARDS can keep the state of oxygenation well before and after suctioning, correct the hypoxia induced by suctioning, Improve lung compliance, and can shorten the mechanical ventilation time and reduce the incidence of atelectasis and pulmonary infection.