陈美玲　夏素琴　康育兰

【摘要】 目的：探討密闭式吸痰法对机械通气患儿气道压力及血气指标的影响。方法：选取2017年1月-2019年12月于笔者所在医院接受机械通气治疗的100例患儿，依据盲抽法分为对照组（n=48）与观察组（n=52）。两组均予以常规治疗，在此基础上，对照组予以开放式吸痰法，观察组予以密闭式吸痰法，比较两组患儿气道压力、血气指标、炎性指标、气道损伤率及病死率。结果：吸痰后，两组气道压力均较吸痰前低，且观察组较对照组低，差异有统计学意义（P<0.05）;吸痰后，两组SaO2、PaO2水平均较吸痰前高，PaCO2水平较吸痰前低，且观察组上述指标均优于对照组，差异有统计学意义（P<0.05）;治疗后，两组CRP、TNF-α、IL-6水平均较治疗前低，且观察组较对照组低，差异有统计学意义（P<0.05）;与对照组气道损伤率（18.75%）相比，观察组（3.85%）低，差异有统计学意义（P<0.05）;与对照组病死率（4.17%）相比，观察组（1.92%）略低，差异无统计学意义（P>0.05）。结论：机械通气患儿采用密闭式吸痰法效果显著，可有效降低患儿气道压力，改善血气指标与炎性指标，同时降低病死率。

【关键词】 机械通气 密闭式吸痰法 气道压力 血气指标

doi：10.14033/j.cnki.cfmr.2020.21.071 文献标识码 B 文章编号 1674-6805（2020）21-0-03

Effect of Closed Sputum Suction on Inflammatory Index and Airway Injury in Children with Mechanical Ventilation/CHEN Meiling， XIA Suqin， KANG Yulan. //Chinese and Foreign Medical Research， 2020， 18（21）： -175

[Abstract] Objective： To investigate the effect of closed sputum suction on airway pressure and blood gas index in children with mechanical ventilation. Method： A total of 100 children who received mechanical ventilation in our hospital from January 2017 to December 2019 were divided into control group （n=48） and observation group （n=52） according to blind extraction. The two groups were treated routinely. On this basis， the control group was treated with open sputum suction， and the observation group was treated with closed sputum suction to compare the airway pressure， blood gas index， inflammatory index， airway injury rate and fatality rate of the two groups. Result： The airway pressure of the two groups was lower than that before sputum aspiration， and the observation group was lower （P<0.05）. The levels of SaO2 and PaO2 in the two groups were higher than those before sputum aspiration， the levels of PaCO2 were lower than those before sputum aspiration， and the above indexes in the observation group were better than those in the control group （P<0.05）. After treatment， the levels of CRP， TNF-α and IL-6 in the two groups were lower than those before treatment， and those were lower in the observation group （P<0.05）. Compared with the control group， the gas channel injury rate of 18.75% was lower than 3.85% of the observation group （P<0.05）. The fatality rate of observation group 1.92% was slightly lower than 4.17% of control group， but the difference was not statistically significant （P>0.05）. Conclusion： The method of closed sputum suction can effectively reduce airway pressure， improve blood gas index and inflammatory index， and reduce mortality.

[Key words] Mechanical ventilation Closed sputum suction Airway pressure Blood gas index

First-authors address： Fujian Provincial Maternal and Child Health Hospital， Fuzhou 350001， China

机械通气是指在呼吸机的帮助下，维持气道通畅，预防机体出现缺氧与二氧化碳蓄积情况，在临床中常用于新生儿肺炎治疗中，可有辅助新生儿通气，改善临床症状，但临床应用发现，长期使用机械通气，易导致患儿气管中产生大量的痰液堆积，严重影响通气效果，故在机械通气治疗总辅以有效的吸痰方式，可提升临床治疗效果[1-2]。密闭式吸痰法、开放式吸痰法均为目前常用的吸痰方式，均具有清除气道，促进患儿有效呼吸的作用，两种方式主要区别在于选取的吸痰管不一致，对患儿预后也产生不同影响[3]。但對何种方式效果更优，仍存争议。鉴于此，本研究将探讨密闭式吸痰法对机械通气患儿气道压力及血气指标的影响，现报告如下。……