摘要
目的探讨肺内叩击通气(IPV)在上腹部术后机械通气患者中的治疗效果.方法选择2021年12月至2022年12月南京医科大学附属逸夫医院重症医学科收治的68例上腹部术后机械通气患者为研究对象,采用随机数字表法分为观察组(34例)和对照组(34例).观察组患者采用IPV治疗,对照组采用常规胸部物理治疗.比较两组患者治疗前和治疗后1、3、5d痰量、氧合指数、动脉血二氧化碳分压(PaCO_(2))、气道峰压水平以及两组患者肺不张发病率、肺炎发病率、机械通气时间、ICU住院时间及28 d病死率;比较两组患者治疗前后收缩压、心率及呼吸频率变化.结果两组患者治疗前及治疗后1、3、5d痰量、氧合指数、PaCO_(2)及气道峰压比较,差异均有统计学意义(F=28.606、30.316、18.276、21.143,P=0.014、0.008、0.026、0.018):进一步两两比较发现,观察组治疗后1、3、5d痰量、氧合指数均显著高于对照组同时间点,PaCO_(2)、气道峰压均显著低于对照组同时间点(P均<0.05).观察组患者治疗后肺不张发生率[11.76%(4/34)vs.23.53%(8/34),χ^(2)=3.245,P=0.011]、肺炎发生率[8.82%(3/34)vs.17.65%(6/34),χ^(2)=2.632,P=0.018]、机械通气时间[(36±24)h vs.(73±40)h,t=3.726,P=0.012]和ICU住院时间[(5.4±2.6)d vs.(7.4±3.1)d,t=2.123,P=0.034]均明显低于对照组.但观察组与对照组患者治疗后收缩压[(128±13)mmHg vs.(125±10)mmHg,t=1.323,P=0.287]、心率[(88±6)次/min vs.(87±13)次/min,t=3.154,P=0.072]、呼吸频率[(20±6)次/min vs.(19±5)次/min,t=1.018,P=0.351]及28 d病死率[2.94%(1/34)vs.5.88%(2/34),2=1.024,P=0.175]比较,差异均无统计学意义.结论IPV可促进上腹部术后机械通气患者排痰,改善氧合和通气功能,降低肺不张及肺炎发生率,缩短机械通气时间及ICU住院时间,且安全、可耐受.
Objective To explore the therapeutic effect of intrapulmonary percussion ventilation(IPV)in patients with mechanical ventilation after upper abdominal surgery.Methods A total of 68 patients with mechanical ventilation after upper abdominal surgery admitted to the Department of Critical Care Medicine in the Sir Run Run Hospital,Nanjing Medical University from December 2021 to December 2022 were selected,who were divided into a observation group(34 cases)and a control group(34 cases)by a random number table method.Patients in the observation group were treated with IPV and patients in the control group were treated with conventional chest physiotherapy.The sputum volume,oxygenation index,arterial partial pressure of carbon dioxide(PaCO_(2))and airway peak pressure before treatment and at 1,3 and 5 d after treatment were compared between the two groups,as well as the incidence of atelectasis and pneumonia,duration of mechanical ventilation,length of ICU stay and 28 d mortality.Then the systolic blood pressure,heart rate and respiratory rate were compared between the two groups before and after treatment.Results There were significant differences in the sputum volume,oxygenation index,PaCO_(2)and airway peak pressure before treatment and at 1,3 and 5 d after treatment between the observation group and control group(F=28.606,30.316,18.276,21.143;P=0.014,0.008,0.026,0.018).Further pairwise comparisons found that the sputum volume and oxygenation index in the observation group were significantly higher than those in the control group at 1,3 and 5 d after treatment,while the PaCO_(2)and airway peak pressure were significantly lower(all P<0.05).The incidence of postoperative atelectasis[11.76%(4/34)vs.23.53%(8/34),χ^(2)=3.245,P=0.011],incidence of pneumonia[8.82%(3/34)vs.17.65%(6/34),χ^(2)=2.632,P=0.018],duration of mechanical ventilation[(36±24)h vs.(73±40)h,t=3.726,P=0.012]and length of ICU stay[(5.4±2.6)d vs.(7.4±3.1)d,t=2.123,P=0.034]in the observation group were significantly lower than those in the control gro
作者
薛翔
陈娇
贾凌
杨敬辉
蔡建芹
陈昆仑
赵炜
Xue Xiang;Chen Jiao;Jia Ling;Yang Jinghui;Cai Jianqin;Chen Kunlun;Zhao Wei(Department of Critical Care Medicine,Sir Run Run Hospital,Nanjing Medical University,Nanjing 211100,China)
出处
《中华危重症医学杂志（电子版）》
CAS
CSCD
2023年第6期469-474,共6页
Chinese Journal of Critical Care Medicine:Electronic Edition
基金
江苏省卫生健康委医学科研立项项目(M2022033)。
关键词
肺内叩击通气
上腹部手术
机械通气
术后肺部并发症
肺不张
Intrapulmonary percussion ventilation
Epigastric surgery
Mechanical ventilation
Postoperative pulmonary complications
Atelectasis
