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目的探讨机械通气新生儿应用不同吸痰方式对通气效果及并发症的影响。方法选择2010年9月至2011年4月湖北省人民医院儿科收治、进行有创机械通气超过48h的新生儿,随机分为观察组和对照组。观察组使用密闭式吸痰管,对照组使用普通开放式吸痰方法,各组均为4～6h进行一次吸痰操作。观察两组患儿机械通气持续时间、呼吸机相关性肺炎(VAP)、颅内出血等并发症发生率及患儿相关生命体征变化,并对观察组使用密闭式吸痰管前后动脉血气分析结果进行比较。结果观察组机械通气时间明显短于对照组[(62.3±9.4)h比(75.3±13.9)h,P<0.05],VAP和颅内出血发生率明显低于对照组[23.8%比45.0%,16.7%比37.5%,P<0.05]。血压波动及经皮氧饱和度(TcSPO2)下降程度明显低于对照组[(11.2±8.1)mmHg比(19.3±7.6)mmHg,(10.4±9.5)%比(16.7±10.4)%,P<0.05]。使用密闭式吸痰管吸痰后动脉血气PCO2较吸痰前升高[(45.3±15.4)mmHg比(36.5±19.7)mmHg,P<0.05],而pH、PO2、HCO-3、BE等无明显变化(P<0.05)。结论与开放式吸痰相比,使用密闭式吸痰管吸痰可能减少机械通气持续时间,降低VAP发生率,减少血压和TcSPO2波动,降低颅内出血发生率,值得推荐。
Objective To investigate the effects of different suction methods on ventilation and complications in newborns with mechanical ventilation. Methods From September 2010 to April 2011, pediatric department of Hubei Provincial People’s Hospital admitted neonates with invasive mechanical ventilation over 48 hours and were randomly divided into observation group and control group. Observation group using closed suction tube, the control group using ordinary open suction method, each group were 4 ~ 6h for a suction operation. The duration of mechanical ventilation, the incidence of ventilator-associated pneumonia (VAP), intracranial hemorrhage and other complications and the changes of vital signs in children were observed in two groups. The results of arterial blood gas analysis before and after the closed suction tube were observed in the observation group Compare Results The duration of mechanical ventilation in observation group was significantly shorter than that in control group [(62.3 ± 9.4) h vs (75.3 ± 13.9) h, P <0.05]. The incidence of VAP and intracranial hemorrhage was significantly lower than that of control group [23.8% vs 45.0%, 16.7 % Than 37.5%, P <0.05]. The decrease of blood pressure fluctuation and TcSPO2 was significantly lower than that of the control group [(11.2 ± 8.1) mmHg vs (19.3 ± 7.6) mmHg, (10.4 ± 9.5)% vs (16.7 ± 10.4)%, P <0.05 ]. Compared with sputum, the PCO2 of arterial blood gas after suctioning by closed suction tube increased (45.3 ± 15.4) mmHg (36.5 ± 19.7) mmHg, P <0.05], but no change of pH, PO2, HCO-3 and BE Significant changes (P <0.05). Conclusion Compared with open sputum suctioning, suctioning with a closed suction tube may reduce the duration of mechanical ventilation, reduce the incidence of VAP, reduce the fluctuation of blood pressure and TcSPO2 and reduce the incidence of intracranial hemorrhage, which is worth recommending.