2024 年第 6 期 第 0 卷

在线机械吸排气技术在心脏术后有创机械通气患者中的应用效果观察

Application effect observation of in-line mechanical insufflation-exsufflation technology in patients with invasive mechanical ventilation after cardiac surgery

作者：韩丹诺侯登榜杜中涛王粮山贾明

英文作者：Han Dannuo Hou Dengbang Du Zhongtao Wang Liangshan Jia Ming

单位：首都医科大学附属北京安贞医院心外危重症中心，北京100029

英文单位：Cardiac Surgical Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：心脏术后；在线机械吸排气；导管吸痰；有创机械通气

英文关键词：Aftercardiacsurgery;In-linemechanicalinsufflation-exsufflation;Cathetersuction;Invasivemechanicalventilation

• 摘要：

• 目的 观察在线机械吸排气（IL-MIE）技术在心脏术后有创机械通气患者气道分泌物管理中的临床效果。方法 回顾性选取2015年7月至2020年7月在首都医科大学附属北京安贞医院心脏外科重症监护病房（ICU）进行有创机械通气的体外循环心脏术后患者65例。其中采用常规导管吸痰治疗的33例患者作为对照组，在常规导管吸痰治疗基础上应用自动化的IL-MIE设备治疗的32例患者作为观察组。比较2组患者的一般资料、治疗期间呼吸循环相关指标、临床及预后相关指标。结果 2组患者一般资料比较差异均无统计学意义（均P＞0.05）。治疗开始0 h时，观察组患者心率低于对照组；治疗开始4 h和8 h时，观察组患者动脉血氧分压、氧合指数和静态顺应性均高于对照组，气道平台压和心率均低于对照组（均P＜0.05）。观察组患者导管吸痰治疗次数和机械通气时长少于/短于对照组［0(0,0)次比3(1,4)次、20(17,22)h比24(19,26)h,Z=-7.081、-2.067，均P＜0.05］。结论 IL-MIE技术通过模拟生理性气道廓清清除气道分泌物，对心脏术后患者氧合指数及气道顺应性的提高，机械通气时长的减少和呼吸道管理时维持血流动力学稳定有重大意义。

• Objective To observe the clinical effect of in-line mechanical insufflation-exsufflation (IL-MIE) technology in airway secretion management of patients with invasive mechanical ventilation after cardiac surgery. Methods A total of 65 patients with invasive mechanical ventilation after cardiac surgery with cardiopulmonary bypass in the Cardiac Surgical Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University from July 2015 to July 2020 were retrospectively selected. Among them, 33 patients treated with conventional catheter suction (CS) were selected as the control group, and 32 patients treated with automated IL-MIE equipment on the basis of conventional CS treatment were selected as the observation group. The general data, respiratory and circulatory related indicators during treatment, clinical and prognostic related indicators of the two groups were compared. Results There were no significant differences in general data between the two groups (all P>0.05). At 0 h after treatment, the heart rate of the observation group was lower than that of the control group; at 4 and 8 h after treatment, the arterial partial pressure of oxygen, oxygenation index and static compliance in the observation group were higher than those in the control group, and the airway plateau pressure and heart rate were lower than those in the control group (all P<0.05). The number of CS treatment and the duration of mechanical ventilation in the observation group were less/shorter than those in the control group ［0(0,0)time vs 3(1,4)times, 20(17,22)h vs 24(19,26)h, Z=-7.081, -2.067, both P<0.05］. Conclusion IL-MIE can improve oxygenation index and airway compliance, reduce the duration of mechanical ventilation and maintain hemodynamic stability during airway management in patients after cardiac surgery by simulating physiological airway clearance.