Clark A P, Winslow E H, Tyler D O, White K M
School of Nursing, University of Texas, Austin 78701.
Heart Lung. 1990 Sep;19(5 Pt 2):552-7.
The purpose of this multisite study was to determine the effects of endotracheal suctioning on mixed venous oxygen saturation (SvO2) and heart rate in 189 critically ill adults. One-pass, intermittent suction was applied for 10 or fewer seconds, with three prehyperoxygenation and three posthyperoxygenation breaths of 100% oxygen. Subjects at three hospitals (n = 127) underwent suctioning using hyperoxygenation with anesthesia bags and traditional suction catheters (open suction method). Subjects at one hospital (n = 62) underwent suctioning with hyperoxygenation by ventilator and in-line suction catheters (closed suction method). For subjects from all hospital sites combined, the SvO2 decreased from 67% to 64% (p = 0.001), a 4% change from baseline, and returned to baseline within 2 minutes. However, in subjects receiving the open method of suction, SvO2 dropped from 66% to 62% immediately after suctioning and returned to baseline within 4 minutes. In contrast, when the closed suction method was used, SvO2 rose from 67.7% to 67.86% immediately after suctioning, drifting upward to 71% for the next 2 minutes before dropping toward the baseline after 4 minutes. Mean heart rate increased from a baseline of 99 beats/min to 104 beats/min immediately after suctioning (p = 0.001), a 5% change from baseline, and gradually returned to baseline over the next 4 minutes. No significant differences were seen in heart rate between subjects having the open versus closed suction method. In conclusion, the closed suction method showed a higher SvO2 after endotracheal suctioning compared with the open suction method (p = 0.0001). Some form of hyperoxygenation before and after endotracheal suctioning is recommended.
这项多中心研究的目的是确定气管内吸痰对189名危重症成年患者的混合静脉血氧饱和度（SvO2）和心率的影响。采用单次、间歇性吸痰，持续10秒或更短时间，吸痰前后各进行3次100%氧气的预充氧和后充氧呼吸。三家医院的127名受试者使用麻醉袋和传统吸痰导管进行充氧吸痰（开放吸痰法）。一家医院的62名受试者通过呼吸机和内置吸痰导管进行充氧吸痰（密闭吸痰法）。对于所有医院的受试者，SvO2从67%降至64%（p = 0.001），较基线变化4%，并在2分钟内恢复到基线水平。然而，采用开放吸痰法的受试者，吸痰后SvO2立即从66%降至62%，并在4分钟内恢复到基线水平。相比之下，采用密闭吸痰法时，吸痰后SvO2立即从67.7%升至67.86%，在接下来的2分钟内上升至71%，4分钟后降至基线水平。平均心率从基线的99次/分钟立即升至吸痰后的104次/分钟（p = 0.001），较基线变化5%，并在接下来的4分钟内逐渐恢复到基线水平。开放吸痰法与密闭吸痰法受试者的心率无显著差异。总之，与开放吸痰法相比，密闭吸痰法在气管内吸痰后SvO2更高（p = 0.0001）。建议在气管内吸痰前后采用某种形式的充氧。
