本文關(guān)鍵詞： 呼吸衰竭 撤機(jī) 有創(chuàng)無創(chuàng)序貫通氣　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討氣管切開插管有創(chuàng)機(jī)械通氣患者保留氣管套管實施有創(chuàng)-無創(chuàng)序貫通氣撤機(jī)策略的可行性與優(yōu)勢,并為氣管套管的設(shè)計提供新的思路。方法:回顧性分析2012年1月—2014年10月在我院老年呼吸內(nèi)科病房及ICU住院治療50例接受氣管切開機(jī)械通氣的呼吸衰竭患者出現(xiàn)肺部感染控制窗(PIC窗)后分別采用傳統(tǒng)撤機(jī)者(傳統(tǒng)組)及直接封堵氣切套管行有創(chuàng)-無創(chuàng)序貫通氣撤機(jī)者(序貫組)的臨床資料;其中男36例,女14例,常規(guī)撤機(jī)組逐步減少SIMV指令頻率,降低支持力度,而序貫撤機(jī)組患者達(dá)到擬撤機(jī)標(biāo)準(zhǔn)后,保留氣切套管,將氣切套管cuff氣囊的氣體排出后直接采用一次性采血管帽封堵氣切套管,使用口鼻面罩連接無創(chuàng)呼吸機(jī)進(jìn)行輔助通氣,觀察兩組在PIC窗后試撤機(jī)1小時及24小時的血氣分析結(jié)果、呼吸機(jī)相關(guān)性肺炎(VAP)發(fā)生率、機(jī)械輔助通氣時間、撤機(jī)成功率、住院總費用等的差別。結(jié)果:50例患者中行有創(chuàng)無創(chuàng)序貫撤機(jī)者(序貫組)26例次,傳統(tǒng)撤機(jī)者(傳統(tǒng)組)24例次,兩組患者年齡、性別及病程均無差異,撤機(jī)前傳統(tǒng)組與序貫組淺快呼吸指數(shù)(RVR)分別為67.8±16.4與70.5±14.6、血氣分析結(jié)果PaO2(mmHg)分別為80.73±9.64與79.61±8.86、PaCO2(mmHg)分別為46.56±8.63與51.08±7.85等,差異沒有顯著性(P0.05),說明兩組具有可比性,有創(chuàng)-無創(chuàng)序貫撤機(jī)組與傳統(tǒng)撤機(jī)組PIC窗后試脫機(jī)1小時及24小時動脈血氣PaO2(mmHg)分別為79.79±9.43、65.54±7.26及88.04±9.85、75.06±8.76,VAP發(fā)生例數(shù)分別為4例、9例,機(jī)械通氣時間分別為8.9±7.65天、15.3±6.78天,成功撤機(jī)例數(shù)分別為21例、16例,住院總費用分別為5.3±2.62、8.4±3.76萬元。結(jié)論:1.有創(chuàng)-無創(chuàng)序貫撤機(jī)組PIC窗后試脫機(jī)1小時及24小時動脈血氣分析結(jié)果改善明顯、VAP發(fā)生率低、機(jī)械輔助通氣時間縮短、撤機(jī)成功率高、住院總費用降低。2.保留氣切套管患者實施有創(chuàng)-無創(chuàng)序貫通氣撤機(jī)策略切實可行,值得臨床進(jìn)一步推廣應(yīng)用。3.將氣切套管cuff氣囊的氣體排出后直接封堵氣切套管,實施有創(chuàng)-無創(chuàng)通氣策略在臨床上成功應(yīng)用,因此我們提出可以將氣管套管附接一“帽狀”結(jié)構(gòu),方便有創(chuàng)無創(chuàng)通氣的切換,為氣管套管的設(shè)計提供了新的思路。
[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 鹵16.4 and 70.5 鹵14.6 in traditional group and sequential group before weaning, and PaO2mm Hg of blood gas analysis was 80.73 鹵9.64 and 79.61 鹵8.86 鹵8.86 mm Hg, respectively. The difference was not significant (P 0.05). The incidence of arterial blood gas (PaO2mm Hg) was 79.79 鹵9.43 鹵65.54 鹵7.26 and 88.04 鹵9.85 鹵75.06 鹵8.76 in 4 cases and 15.3 鹵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 鹵7.65 days / 15.3 鹵6.78 days, respectively, and the incidence rate of arterial blood gas was 79.79 鹵9.43 鹵7.26 and 88.04 鹵9.85 鹵7.76 鹵8.76 / h respectively, and the duration of mechanical ventilation was 8.9 鹵7.65 days / 15.3 鹵6.78 days, respectively. The total cost of hospitalization was 5.3 鹵2.62 鹵8.4 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.8

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