密闭式吸痰对急性呼吸窘迫综合征病人血气分析与肺损伤评分的影响(1)

http://www.100md.com 2011年7月1日 曾佩 蔡施霞 林艺珍 何春玲 张媛莉

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     【摘要】目的:观察密闭式吸痰(CS)对急性呼吸窘迫综合征患者动脉血气分析与肺损伤评分的影响。方法:选择60例诊断 ARDS并机械通气治疗的患者，随机分为开放式吸痰(OS)组和密闭式吸痰(CS)组，分别采用开放式吸痰和密闭式吸痰两种吸痰方式，观察记录患者吸痰前1min及吸痰后3min和20min动脉血氧分压(PaO2) 、动脉血氧饱和度(SaO2) 、动脉血二氧化碳分压(PaCO2) 、动脉血pH 值变化情况及实行不同吸痰方式后3d对肺损伤评分的影响。结果:OS组吸痰后3min、20min与吸痰前1min比较,PaO2、SaO2显著下降(P<0.05)；CS组吸痰前后上述参数变化无统计学意义(P>0.05)。在吸痰3d后OS组肺损伤评分较CS组肺损伤评分明显增加(P<0.05)。两种吸痰方式对患者PaCO2、动脉血pH 值无明显影响。结论:ARDS患者选择CS方式吸痰能较好地维持机体氧合状态，具有一定的肺保护作用，为ARDS病人的气道管理提供更安全可靠的手段。

    【关键词】密闭式吸痰；急性呼吸窘迫综合征；血气分析；肺损伤评分

    The influences of closed suction (CS) on the arterial blood gas and Lung injury score (LIS) of patients with acute respiratory distress syndrome

    Zeng Pei Cai Shixia Lin Yizhen He ChunlinZhang Yuanli

    【Abstract】Objective To observe the influence of closed suction(CS) on the acute respiratory distress syndrome (ARDS) patients' arterial blood gas and Lung injury score (LIS). Method 60 ARDS patients with mechanical ventilation therapy were randomly divided into the open suction (OS) group and the closed suction group (n=30) which were treated with open suction and closed suction separately. The changes of Arterialoxygen partial pressure (PaO2)，Arterial Oxygen Saturation(SaO2) ,Arterial carbon dioxide partial pressure ( PaCO2) and PH were observed the before suction 1min,andafter suction 3min、20min in patients.The lung injury score were determined after 3 days of mechanical ventilation. Result The PaO2, SaO2 decreased significantly (P <0.05) after suction 3min,20min than 1 min before suction in OS group. There were no significant differences of the PaO2, SaO2 in CS group (P> 0.05). Furthermore the LIS increase significantly in OS group than those in CS group after 3 days (P <0.05). Conclusion It is better to choose CS for ARDS patients which provide a safe way to maintain oxygenation

    【Key words】Closed suction, ARDS，arterial blood gas analysis，Lung injury score

    【中图分类号】R165 【文献标识码】B 【文章编号】1005-0515(2011)07-0001-02

    急性肺损伤(acute lung injury, ALI)是由于各种原因引起的肺组织结构发生特征性的病理改变而出现的临床综合征，其病理特点为肺泡毛细血管内皮细胞和肺泡上皮细胞损伤，表现为广泛肺水肿和微小肺不张，病理生理改变主要是肺内分流增加和肺顺应性下降。ALI有着从轻到重的连续过程，严重的ALI被定义为急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)。ARDS表现为急性、进行性加重的呼吸困难、难治性低氧血症和肺水肿,是机械通气的绝对适应症 ......

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