江静霞 皇敏 吴湘兰 欧阳玲 邓凤英 满帅

【摘要】目的：观察两种气管导管内吸痰方式对新生儿机械通气的影响。方法：通过选取新生儿重症监护病房66例机械通气患儿为研究对象，分为观察组和对照组，各33例。观察组采用密闭式气管导管内吸痰，对照组选择开放式气管导管内吸痰，比较两组在吸痰前、中、后的经皮血氧饱和度（SpO2）值、肺部感染率。结果：预期对照组吸痰中SpO2值比吸痰前降低；观察组吸痰前后SpO2值差异无显著性。机械通气48 h后两组肺部感染率差异有统计学意义。结论：在新生儿机械通气中采用密闭式吸引装置经气管导管内吸痰更有助于降低机械通气患者低氧血症的发生率，用时较短，避免交叉感染，防止医护人员职业伤害，减少患儿住院时间，可操作性强，对机械通气的患儿治疗更有利，因而，适宜在NICU中推广使用。

【关键词】密闭式吸痰；开放式吸痰 ；新生儿；机械通气

Prone position in adjuvant treatment of apnea of prematurity care analysis

【Abstract】 Objective：objective to observe different endotracheal sputum suction methods on the effects of ventilator associated pneumonia. Method：by selecting neonatal intensive care unit， 66 cases of children with mechanical ventilation as the research object， is divided into observation group and control group， all 33 patients. Observation group adopts closed endotracheal tube of sputum suction control group choose open endotracheal tube in sputum suction， compare two groups in the sputum suction of before， during and after percutaneous oxygen saturation （SpO2） value， the lung infection. Result：Expected in the control group in the sputum suction sputum suction SpO2 value than before； Observation group there was no significant difference SpO2 values before and after the sputum suction. Mechanical ventilation after 48 h lung infection rates similar between the two groups have statistical significance.Conclusion： from new begat machinery ventilation with dense closed sputum suction gas pipe internal more help to reduce the incidence of hypoxemia in patients with mechanical ventilation， shorter time， avoid crossing infection and can prevent medical staff occupational injuries， reduce the length of hospital stay， children to parents to reduce the economic burden， the maneuverability is strong， for the treatment of children with mechanical ventilation in the more advantageous， therefore， is suitable for use in NICU.

机械通气（MV）是危重新生儿生命支持的重要手段，是抢救新生儿呼吸衰竭的重要方式，更是治疗早产儿呼吸窘迫综合征的有效手段。在使用机械通气的过程中，及时吸痰，可以保持顺畅的气道和充足的气体交换，以降低呼吸机相关性肺炎发生率[1]。传统开放式吸痰大多需将呼吸机断开，无法保持长时间氧气供应，容易引发心率、血氧饱和度异常，加上外界因素对吸痰的影响，将会增加感染可能性[2]。随着机械通气在临床的广泛应用，VAP已是ICU、新生儿重症监护病房（neonatal intensive care unit，NICU）主要获得性感染，目前ICU的发生率，可达8～28%[3-4]，国外文献报道VAP在NICU中发生率为28.3%-50%，每用机械通气一天，VAP的发生率增加1%-3%[5]，严重威胁患儿的生命。……