Grap M J, Glass C, Corley M, Parks T
School of Nursing, Virginia Commonwealth University, Richmond, USA.
Am J Crit Care. 1996 May;5(3):192-7.
Despite a large number of studies on endotracheal suctioning, there is little data on the impact of clinically practical hyperoxygenation techniques on physiologic parameters in critically ill patients.
To compare the manual and mechanical delivery of hyperoxygenation before and after endotracheal suctioning using methods commonly employed in clinical practice.
A quasi-experimental design was used, with twenty-nine ventilated patients with a lung injury index of 1.54 (mild-moderate lung injury). Three breaths were given before and after each of two suction catheter passes using both the manual resuscitation bag and the ventilator. Arterial pressure, capillary oxygen saturation, heart rate, and cardiac rhythm were monitored for 1 minute prior to the intervention to obtain a baseline, continuously throughout the procedure, and for 3 minutes afterward. Arterial blood gases were collected immediately prior to the suctioning intervention, immediately after, and at 30, 60, 120, and 180 seconds after the intervention. Data were analyzed with repeated measures analysis of variance.
Arterial oxygen partial pressures were significantly higher using the ventilator method. Peak inspiratory pressures during hyperoxygenation were significantly higher with the manual resuscitation bag method. Significant increases were observed in mean arterial pressure during and after suctioning, with both delivery methods, with no difference between methods. Maximal increases in arterial oxygen partial pressure and arterial oxygen saturation occurred 30 seconds after hyperoxygenation, falling to baseline values at 3 minutes for both methods.
Using techniques currently employed in clinical practice, these findings support the use of the patient's ventilator for hyperoxygenation during suctioning.
尽管对气管内吸痰进行了大量研究，但关于临床实用的高氧合技术对重症患者生理参数影响的数据却很少。
采用临床常用方法比较气管内吸痰前后手动和机械进行高氧合的情况。
采用准实验设计，纳入29例肺损伤指数为1.54（轻度至中度肺损伤）的机械通气患者。在使用两种吸痰导管进行两次吸痰操作的前后，分别使用手动复苏袋和呼吸机给予三次呼吸。在干预前监测动脉压、毛细血管血氧饱和度、心率和心律1分钟以获取基线值，在整个过程中持续监测，并在干预后监测3分钟。在吸痰干预前、干预后即刻以及干预后30、60、120和180秒采集动脉血气。采用重复测量方差分析对数据进行分析。
使用呼吸机方法时动脉血氧分压显著更高。使用手动复苏袋方法时高氧合期间的吸气峰压显著更高。两种给药方法在吸痰期间和吸痰后平均动脉压均显著升高，两种方法之间无差异。动脉血氧分压和动脉血氧饱和度的最大升高发生在高氧合后30秒，两种方法在3分钟时均降至基线值。
使用目前临床实践中采用的技术，这些发现支持在吸痰期间使用患者的呼吸机进行高氧合。
