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中华危重症医学杂志(电子版) ›› 2023, Vol. 16 ›› Issue (06) : 469 -474. doi: 10.3877/cma.j.issn.1674-6880.2023.06.005

论著

肺内叩击通气在上腹部术后机械通气患者中的疗效分析
薛翔, 陈娇, 贾凌, 杨敬辉, 蔡建芹, 陈昆仑, 赵炜†()   
  1. 211100　南京，南京医科大学附属逸夫医院重症医学科
  • 收稿日期:2023-05-06 出版日期:2023-12-31
  • 通信作者: 赵炜
  • 基金资助:
    江苏省卫生健康委医学科研立项项目(M2022033)

Curative effect of intrapulmonary percussion ventilation in patients with mechanical ventilation after upper abdominal surgery

Xiang Xue, Jiao Chen, Ling Jia, Jinghui Yang, Jianqin Cai, Kunlun Chen, Wei Zhao†()   

  1. Department of Critical Care Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
  • Received:2023-05-06 Published:2023-12-31
  • Corresponding author: Wei Zhao
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薛翔, 陈娇, 贾凌, 杨敬辉, 蔡建芹, 陈昆仑, 赵炜. 肺内叩击通气在上腹部术后机械通气患者中的疗效分析[J/OL]. 中华危重症医学杂志(电子版), 2023, 16(06): 469-474.

Xiang Xue, Jiao Chen, Ling Jia, Jinghui Yang, Jianqin Cai, Kunlun Chen, Wei Zhao. Curative effect of intrapulmonary percussion ventilation in patients with mechanical ventilation after upper abdominal surgery[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(06): 469-474.

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、5 d痰量、氧合指数、动脉血二氧化碳分压（PaCO2）、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、5 d痰量、氧合指数、PaCO2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、5 d痰量、氧合指数均显著高于对照组同时间点，PaCO2、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），χ2 = 3.245，P = 0.011]、肺炎发生率[8.82%（3/34）vs. 17.65%（6/34），χ2 = 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），χ2 = 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。

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
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 (PaCO2) 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, PaCO2 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 PaCO2 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), χ2 = 3.245, P = 0.011], incidence of pneumonia [8.82% (3/34) vs. 17.65% (6/34), χ2 = 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 group. However, there were no significant differences in the systolic blood pressure [(128 ± 13) mmHg vs. (125 ± 10) mmHg, t = 1.323, P = 0.287], heart rate [(88 ± 6) beats/min vs. (87 ± 13) beats/min, t = 3.154, P = 0.072], respiratory rate [(20 ± 6) breaths/min vs. (19 ± 5) breaths/min, t = 1.018, P = 0.351] and 28 d mortality [2.94% (1/34) vs. 5.88% (2/34), χ2 = 1.024, P = 0.175] between the observation group and control group after treatment.

Conclusion

IPV can promote sputum excretion, improve oxygenation and ventilation function, reduce the incidence of atelectasis and pneumonia, and shorten the duration of mechanical ventilation and ICU stay in mechanically ventilated patients after upper abdominal surgery, which is safe and tolerable.

Key words: Intrapulmonary percussion ventilation, Epigastric surgery, Mechanical ventilation, Postoperative pulmonary complications, Atelectasis
表1 两组上腹部术后机械通气患者一般资料比较
组别 例数 年龄（岁， ± s） 性别（例，男/女） 吸烟[例（%）] COPD[例（%）] 哮喘[例（%）] 肥胖[例（%）] OSAS[例（%）]
观察组 34 66 ± 24 20/14 12（35.29） 7（20.59） 4（11.76） 8（23.53） 4（11.76）
对照组 34 63 ± 20 18/16 10（29.41） 6（17.65） 5（14.71） 6（17.65） 3（8.82）
t/χ2值   1.725 2.234 2.245 0.854 1.476 2.156 1.813
P值   0.185 0.128 0.125 0.307 0.216 0.135 0.204
组别 例数 ASA分级[例（%）] 手术类型[例（%）]
ASA 2级+并发症 ASA 3级 ASA 4级/ASA 5级 胃十二指肠手术 胆道胰腺手术 肝脾手术
观察组 34 7（20.59） 22（64.71） 5（14.71） 19（55.88） 9（26.47） 6（17.65）
对照组 34 9（26.47） 21（61.76） 4（11.76） 17（50.00） 10（29.41） 7（20.59）
t/χ2值   1.054 2.549 1.723 1.835 1.942 2.726
P值   0.278 0.105 0.184 0.212 0.187 0.134
表2 两组上腹部术后机械通气患者治疗前及治疗后不同时间点痰量、氧合指数、PaCO2及气道峰压水平比较（ ± s）
组别 例数 痰量（mL） 氧合指数（mmHg） PaCO2（mmHg） 气道峰压（mmHg）
观察组          
治疗前 34 31 ± 5 189 ± 32 47 ± 7 18 ± 4
治疗后1 d 34 37 ± 5a 233 ± 28a 41 ± 5a 13 ± 3a
治疗后3 d 34 37 ± 5a 258 ± 25a 37 ± 5a 12 ± 4a
治疗后5 d 34 33 ± 4a 281 ± 30a 36 ± 6a 13 ± 4a
对照组          
治疗前 34 33 ± 4 195 ± 36 46 ± 6 17 ± 5
治疗后1 d 34 34 ± 5 212 ± 22 43 ± 6 16 ± 4
治疗后3 d 34 36 ± 3 233 ± 27 40 ± 5 15 ± 3
治疗后5 d 34 28 ± 5 251 ± 25 39 ± 4 16 ± 5
F值   28.606 30.316 18.276 21.143
P值   0.014 0.008 0.026 0.018
表3 两组上腹部术后机械通气患者治疗前后收缩压、心率及呼吸频率比较（ ± s）
组别 例数 收缩压（mmHg） 心率（次/min） 呼吸频率（次/min）
观察组        
治疗前 34 121 ± 14 82 ± 11 18 ± 3
治疗后 34 128 ± 13 88 ± 6 20 ± 6
对照组        
治疗前 34 117 ± 12 80 ± 11 16 ± 5
治疗后 34 125 ± 10 87 ± 13 19 ± 5
表4 两组上腹部术后机械通气患者治疗后预后指标比较（ ± s）
组别 例数 机械通气时间（h） ICU住院时间（d） 28 d病死率[例（%）]
观察组 34 36 ± 24 5.4 ± 2.6 1（2.94）
对照组 34 73 ± 40 7.4 ± 3.1 2（5.88）
t/χ2值   3.726 2.123 1.024
P值   0.012 0.034 0.175
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