腹部电刺激联合气道廓清技术对气管切开重症患者咳嗽能力及拔管成功率的影响

关键词：腹部电刺激  气道廓清技术  气管切开  拔管

Keywords:abdominal electrical stimulation  airway clearance technique  tracheotomy  tube drawing

摘要：

      摘要 目的：观察腹部电刺激联合气道廓清技术对气管切开重症患者咳嗽能力及拔管成功率的影响。 方法：采用随机、双盲、对照试验，将符合纳入标准的52例气管切开患者分为对照组和试验组，每组26例，在观察期间对照组和试验组各有1例患者脱落。两组患者均给予气道廓清技术，试验组在气道廓清技术的基础上增加腹部电刺激治疗，观察周期为6周，治疗前后使用非自主咳嗽峰流速（ICPF），临床肺部感染评分（CPIS）、气管套管拔管时间、拔管成功率比较临床疗效的差异。 结果：训练前，两组患者的ICPF组间差异无显著性意义（P>0.05），但在第1、3、6周时，试验组的ICPF评分明显高于对照组，差异具有显著性意义（P<0.05）；训练前，两组患者的CPIS评分组间差异无显著性意义（P>0.05），但在第1、3、6周后，试验组的CPIS评分均较对照组明显降低，差异具有显著性意义（P<0.05）；训练前，两组患者的腹部肌肉厚度差异无显著性意义（P>0.05），在第3、6周时，试验组的腹部肌肉厚度明显高于对照组，差异具有显著性意义（P<0.05）。试验组的拔管时间比对照组明显缩短（P<0.05）；且试验组的拔管成功率为92%，明显高于对照组的76%，差异具有显著性意义（P<0.05）。 结论：腹部电刺激联合气道廓清技术能显著提高气管切开重症患者的咳嗽能力，缩短气管套管的拔除时间，提高拔管的成功率。

Abstract:

      Abstract Objective：To observe the effect of abdominal electrical stimulation combined with airway clearance on cough ability and success rate of extubation in patients with severe tracheotomy. Method：A randomized， double-blind， controlled trial was conducted. 52 patients with tracheotomy who met the inclusion criteria were divided into a control group and an experimental group， with 26 cases in each group. The experimental group was treated with abdominal electrical stimulation on the basis of airway clearance technique. The observation period was 6 weeks. Before and after treatment， involuntary cough peak flow rate （ICPF）， clinical pulmonary infection score （CPIS）， tracheal tube extubation time and extubation success rate were used to compare the differences in clinical efficacy. Result：Before the training， there was no significant difference in ICPF between the two groups （P>0.05）， but at 1， 3 and 6 weeks， the ICPF score of the experimental group was significantly higher than that of the control group （P<0.05）. Before training， there was no significant difference in CPIS score between the two groups （P>0.05）， but after 1， 3 and 6 weeks， the CPIS score of the experimental group was significantly lower than that of the control group， and the difference was statistically significant （P<0.05）. Before training， there was no significant difference in abdominal muscle thickness between the two groups （P>0.05）. At the 3rd and 6th week， the abdominal muscle thickness of the experimental group was significantly higher than that of the control group， and the difference was statistically significant （P<0.05）. The extubation time of the experimental group was significantly shorter than that of the control group （P<0.05）. The success rate of extubation in the experimental group was 92%， which was significantly higher than that in the control group （76%）， and the difference was statistically significant （P<0.05）. Conclusion：Abdominal electrical stimulation combined with airway clearance can significantly improve the cough ability of patients with severe tracheotomy， shorten the time of tracheal cannula removal， and improve the success rate of extubation.