早期机械通气应用于急性重型颅脑损伤患者临床研究.docVIP

早期机械通气应用于急性重型颅脑损伤患者临床研究 　　【摘要】 目的 探讨重型颅脑损伤患者早期机械通气的治疗效果及其护理。方法 将250例GCS评分5~8分的重型颅脑损伤患者依有否进行早期机械通气分为实验组128例及对照组122例，两组均行脑损伤常规治疗护理，及时准确的机械通气的监测，正确选择呼吸机模式和参数，加强人工气道的护理及基础护理。对治疗前后两组患者的氧饱和度(SaO?2)、氧分压(PaO?2)、二氧化碳分压(PaCO?2)、血压(BP)、心率(HR)、GCS评分和预后进行评估。结果 治疗后实验组与对照组间的氧饱和度(SaO?2)、氧分压(PaO?2)、二氧化碳分压(PaCO?2)比较差异有统计学意义(P 　　【关键词】机械通气;颅脑损伤;氧饱和度;护理 　　The clinical study of early mechanical ventilation in the treatment of patients with severe craniocerebral injury 　　 　　Yan Yan-ling, Li Yun-ling, Luo Jin-ling, et al. 　　The First People’s Hospital of Zhaoqing City,Zhaoqing 526021,China 　　【Abstract】 Objective To explore the effect and nursing care in acute severe craniocerebral injury patients treated by early stage ventilation.Methods 250 patients(GCS 5-8)with severe craniocerebral injury were divided into the treatment group(n=128)and control group(n=122)according to whether early mechanical ventilation. The routine treatment and nursing were performed for all patients, monitoring the mechanical ventilation in time, a correct choice of ventilation modes and parameters, and strengthening the nursing of artificial airway and basic nursing. The oxygen saturation(SaO?2), oxygen partial pressure(PaO?2), partial pressure of carbon dioxide(PaCO?2), blood pressure(BP), heart rate(HR), GCS score and prognosis in two groups were compared and assessed before and after treatment. Results The differences in SaO?2, PaO?2 and PaCO?2 between treatment group and control group were statistically significant after treatment(P 　　2 结果 　　对照组98例出现呼吸功能衰竭并使用呼吸机，呼吸机使用时间90~908 h；实验组出现呼吸衰竭21例，呼吸机使用时间72~636 h，两组比较差异有统计学意义(P18 mm Hg 时可导致血液回流障碍、黏膜水肿甚至坏死,压力过低则气囊上方的分泌物易进入下呼吸道引起肺部感染［4］。笔者采用“最小封闭压力”技术,确定最小封闭容积为气囊充气依据。基本步骤:将听??器放置于颈部喉及气管部位,给气囊充气,直到气囊周围完全不漏气,听不到气流声;正压通气时,逐渐从气囊抽气,每次抽0.25~0.50 ml气体,直到吸气压力达到高峰时出现少量漏气为止,然后再注入0.25~0.50 ml气体,对于自主呼吸或接受持续气道正压通气治疗的患者,逐渐从气囊抽气,每次抽0.25~0.50 ml气体,直到呼气末出现少量漏气为止,再注0.25~0.50 ml气体。如用专用的气囊测压装置对气囊压力的监测更加精确,可减少并发症。有文献报道,气囊常规性的放气是不必要的,适时的调整对维持气囊的压力是非常有效的措施［5］。 　　3.3 并发