保留气管套管患者实施有创-无创序贯撤机策略的临床应用

发布时间：2018-03-01 22:15

本文关键词： 呼吸衰竭撤机有创无创序贯通气　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨气管切开插管有创机械通气患者保留气管套管实施有创-无创序贯通气撤机策略的可行性与优势,并为气管套管的设计提供新的思路。方法:回顾性分析2012年1月—2014年10月在我院老年呼吸内科病房及ICU住院治疗50例接受气管切开机械通气的呼吸衰竭患者出现肺部感染控制窗(PIC窗)后分别采用传统撤机者(传统组)及直接封堵气切套管行有创-无创序贯通气撤机者(序贯组)的临床资料;其中男36例,女14例,常规撤机组逐步减少SIMV指令频率,降低支持力度,而序贯撤机组患者达到拟撤机标准后,保留气切套管,将气切套管cuff气囊的气体排出后直接采用一次性采血管帽封堵气切套管,使用口鼻面罩连接无创呼吸机进行辅助通气,观察两组在PIC窗后试撤机1小时及24小时的血气分析结果、呼吸机相关性肺炎(VAP)发生率、机械辅助通气时间、撤机成功率、住院总费用等的差别。结果:50例患者中行有创无创序贯撤机者(序贯组)26例次,传统撤机者(传统组)24例次,两组患者年龄、性别及病程均无差异,撤机前传统组与序贯组浅快呼吸指数(RVR)分别为67.8±16.4与70.5±14.6、血气分析结果PaO2(mmHg)分别为80.73±9.64与79.61±8.86、PaCO2(mmHg)分别为46.56±8.63与51.08±7.85等,差异没有显著性(P0.05),说明两组具有可比性,有创-无创序贯撤机组与传统撤机组PIC窗后试脱机1小时及24小时动脉血气PaO2(mmHg)分别为79.79±9.43、65.54±7.26及88.04±9.85、75.06±8.76,VAP发生例数分别为4例、9例,机械通气时间分别为8.9±7.65天、15.3±6.78天,成功撤机例数分别为21例、16例,住院总费用分别为5.3±2.62、8.4±3.76万元。结论:1.有创-无创序贯撤机组PIC窗后试脱机1小时及24小时动脉血气分析结果改善明显、VAP发生率低、机械辅助通气时间缩短、撤机成功率高、住院总费用降低。2.保留气切套管患者实施有创-无创序贯通气撤机策略切实可行,值得临床进一步推广应用。3.将气切套管cuff气囊的气体排出后直接封堵气切套管,实施有创-无创通气策略在临床上成功应用,因此我们提出可以将气管套管附接一“帽状”结构,方便有创无创通气的切换,为气管套管的设计提供了新的思路。
[Abstract]:Objective: to explore the feasibility and advantages of trachea cannula retention in tracheotomy and intubation with invasive mechanical ventilation. Methods: from January 2012 to October 2014, 50 patients with respiratory failure undergoing tracheotomy and mechanical ventilation in our hospital were analyzed retrospectively. After lung infection control window (PIC window), the clinical data of the patients with conventional weaning (traditional group) and those with direct plugging gas cannula (sequential group) were analyzed. Among them, 36 cases were male and 14 cases were female. The routine withdrawal unit gradually reduced the frequency of SIMV instruction and reduced the support strength. However, after the patients of sequential withdrawal unit reached the standard of the proposed weaning machine, the gas cut casing was retained. After removing the gas from the cuff air bag of the gas cut casing, the vessel cap was directly used to block the gas cut casing, and the mouth and nose mask was used to connect the non-invasive ventilator for auxiliary ventilation. The results of blood gas analysis, the incidence of ventilator associated pneumonia, the time of mechanical assisted ventilation, and the success rate of weaning were observed. Results there was no difference in age, sex and course of disease between the two groups (26 cases in the sequential group and 24 times in the traditional group), and there was no difference in age, sex and course of disease between the two groups. RVRwas 67.8 卤16.4 and 70.5 卤14.6 in traditional group and sequential group before weaning, and PaO2mm Hg of blood gas analysis was 80.73 卤9.64 and 79.61 卤8.86 卤8.86 mm Hg, respectively. The difference was not significant (P 0.05). The incidence of arterial blood gas (PaO2mm Hg) was 79.79 卤9.43 卤65.54 卤7.26 and 88.04 卤9.85 卤75.06 卤8.76 in 4 cases and 15.3 卤6.78 days in mechanical ventilation time, respectively, in the PIC window of the invasive and non-invasive sequential weaning unit and the traditional withdrawal unit. The time of mechanical ventilation was 8.9 卤7.65 days / 15.3 卤6.78 days, respectively, and the incidence rate of arterial blood gas was 79.79 卤9.43 卤7.26 and 88.04 卤9.85 卤7.76 卤8.76 / h respectively, and the duration of mechanical ventilation was 8.9 卤7.65 days / 15.3 卤6.78 days, respectively. The total cost of hospitalization was 5.3 卤2.62 卤8.4 卤37,600 yuan respectively. Conclusion 1: 1.The results of 1 hour and 24 hour arterial blood gas analysis of invasive and non-invasive sequential weaning unit showed that the incidence of PIC was significantly lower than that of the control group. The time of mechanical assisted ventilation was shortened, the success rate of weaning was high, the total cost of hospitalization was reduced .2.The strategy of implementing invasive and non-invasive sequential gas withdrawal was feasible in patients with gas cutting. It is worthy of further popularizing the clinical application .3.The gas removal of the gas cut casing cuff airbag and the direct plugging of the gas cut casing, and the successful application of the invasive-noninvasive ventilation strategy in clinic, Therefore, we propose that the trachea cannula can be attached to a "cap" structure to facilitate the switching of invasive and noninvasive ventilation, which provides a new idea for the design of trachea cannula.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.8

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