机械吸-呼技术对ICU咳嗽反射弱/无患者肺部感染的防治效果

doi:10.3969/j.issn.1004-583X.2026.08.004

摘要/Abstract

摘要：

目的探讨机械吸-呼技术预防和治疗气管插管/气管切开且咳嗽反射弱/无患者肺部感染的效果。方法采用随机对照试验选取2022年1月-2023年12月在河北省人民医院收住ICU的气管插管/气管切开且咳嗽反射弱/无患者115例,其中观察组57例、对照组58例。对照组采取叩击排痰、体位引流、雾化吸入、诱导性咳嗽、吸痰等气道廓清方法,观察组采取机械吸-呼技术模拟生理性咳嗽的气道廓清方法。观察比较两组经皮血氧饱和度(SpO₂)、血气指标、肺部感染发生率、肺部感染控制率、临床肺部感染评分、ICU住院时间(天)、总住院时间(天)的差异。结果观察组在治疗后SpO₂和血气指标分别为SpO₂:(95.84±1.77)%,动脉血氧分压(PaO₂):(82.45±2.91) mmHg,动脉血二氧化碳分压(PaCO₂):(37.29±0.88) mmHg,肺泡-动脉氧分压差(A-aDO₂):(28.32±3.03) mmHg,氧合指数:(301.65±9.21) mmHg,均优于对照组的SpO₂:(92.84±1.23)%,PaO₂:(70.89±2.06) mmHg,PaCO₂:(41.10±1.06) mmHg,A-aDO₂:(35.55±2.46) mmHg,氧合指数:(280.98±4.90) mmHg。观察组的肺部感染发生率为3.5%(2/57),低于对照组15.5%(9/58)( P<0.05);观察组的肺部感染控制率为38.6%(22/57),高于对照组20.7%(12/58)( P<0.05)。观察组的CPIS评分为(5.53±1.12)分,低于对照组(6.48±0.10)分(P<0.05);观察组ICU住院时间为(7.41±0.67) d,低于对照组(10.06±0.98)d( P<0.05);两组总住院时间差异均无统计学意义(P>0.05)。结论应用机械吸-呼技术管理气管插管/气管切开且咳嗽反射弱/无患者的气道,能显著减少患者的痰液蓄积,改善氧合指数等血气指标,控制肺部感染,减少ICU住院时间,可行性较高,安全性好,值得普及推广。

关键词: 肺炎, 气管插管, 气管切开, 机械吸-呼技术, 咳嗽反射, 气道分泌物

Abstract:

Objective To investigate the efficacy of the mechanical insufflation-exsufflation (MI-E) in preventing and treating pulmonary infection in intubated or tracheostomized ICU patients with weak or absent cough reflex. Methods A randomized controlled trial was conducted in 115 intubated or tracheostomized patients with weak or absent cough reflex admitted to the ICU of Hebei General Hospital from January 2022 to December 2023, including 57 patients in the observation group and 58 in the control group. The control group received conventional airway clearance measures, such as chest percussion and sputum expectoration, postural drainage, nebulization, induced coughing, and suctioning. The observation group received airway clearance using the MI-E to simulate physiological coughing. The two groups were compared in terms of percutaneous oxygen saturation (SpO₂), blood gas parameters, incidence of pulmonary infection, pulmonary infection control rate, Clinical Pulmonary Infection Score (CPIS), ICU length of stay (days), and total hospital stay (days). Results After treatment, the observation group had better SpO₂ and blood gas parameters than the control group: SpO₂ (95.84±1.77)% vs (92.84±1.23)%, arterial partial pressure of oxygen (PaO₂) (82.45±2.91) mmHg vs (70.89±2.06) mmHg, arterial partial pressure of carbon dioxide (PaCO₂) (37.29±0.88) mmHg vs (41.10±1.06) mmHg, alveolar-arterial oxygen difference (A-aDO₂) (28.32±3.03) mmHg vs (35.55±2.46) mmHg, and oxygenation index (301.65±9.21) mmHg vs (280.98±4.90) mmHg. The incidence of pulmonary infection in the observation group was 3.5% (2/57), lower than 15.5% (9/58) in the control group (P<0.05); the pulmonary infection control rate in the observation group was 38.6% (22/57), higher than 20.7% (12/58) in the control group (P<0.05). The CPIS score in the observation group was (5.53±1.12), lower than that in the control group (6.48±0.10) (P<0.05). The length of ICU stay in the observation group was (7.41±0.67) d, shorter than that in the control group (10.06±0.98) d (P<0.05). There was no statistically significant difference in total length of hospital stay between the two groups (P>0.05). Conclusion Applying the MI-E for airway management in intubated or tracheostomized ICU patients with weak or absent cough reflex can significantly reduce sputum retention, improve blood gas parameters such as the oxygenation index, control pulmonary infection, and shorten ICU stay. The technique is feasible, safe, and worthy of wider clinical application.

Key words: pneumonia, endotracheal intubation, tracheostomy, mechanical insufflation-exsufflation (MI-E), cough reflex, airway secretions

中图分类号:

R563.1

陈芝, 丁朋彦, 郝贵珍, 李玉龙, 牛士良, 申丽旻, 刘春霞. 机械吸-呼技术对ICU咳嗽反射弱/无患者肺部感染的防治效果[J]. 临床荟萃, 2026, 41(8): 695-699.

Chen Zhi, Ding Pengyan, Hao Guizhen, Li Yulong, Niu Shiliang, Shen Limin, Liu Chunxia. Effect of mechanical insufflation-exsufflation technique on the prevention and treatment of pulmonary infection in ICU patients with weak or absent cough reflex[J]. Clinical Focus, 2026, 41(8): 695-699.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.08.004

https://www.lchc.cn/CN/Y2026/V41/I8/695

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参考文献 22

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组别	例数	性别(例)		年龄 (岁)	APACHⅡ评分 (分)	原发病[例(%)]
组别	例数	男	女	年龄 (岁)	APACHⅡ评分 (分)	COPD	神经肌肉疾病	脑卒中	颅脑损伤	重症肺炎
观察组	57	33	24	68.4±14.8	21.6±5.4	7(12.3)	17(29.8)	8(14.0)	18(31.6)	7(12.3)
对照组	58	36	22	68.1±11.2	20.9±7.5	6(10.3)	17(29.3)	9(15.5)	18(31.0)	8(13.8)
χ²/t值		0.209		0.132	1.279	0.194
P值		0.648		0.895	0.203	0.996

组别	例数	性别(例)		年龄 (岁)	APACHⅡ评分 (分)	原发病[例(%)]
组别	例数	男	女	年龄 (岁)	APACHⅡ评分 (分)	COPD	神经肌肉疾病	脑卒中	颅脑损伤	重症肺炎
观察组	57	33	24	68.4±14.8	21.6±5.4	7(12.3)	17(29.8)	8(14.0)	18(31.6)	7(12.3)
对照组	58	36	22	68.1±11.2	20.9±7.5	6(10.3)	17(29.3)	9(15.5)	18(31.0)	8(13.8)
χ²/t值		0.209		0.132	1.279	0.194
P值		0.648		0.895	0.203	0.996

组别	例数		SpO₂(%)			PaO₂(mmHg)			PaCO₂(mmHg)
组别	例数		治疗前	治疗后		治疗前		治疗后	治疗前		治疗后
观察组	57		89.89±1.84	95.84±1.77^*		62.41±1.72		82.45±2.91^*	48.01±3.28		37.29±0.88^*
对照组	58		90.10±2.17	92.84±1.23^*		62.80±2.19		70.89±2.06^*	48.86±2.04		41.10±1.06^*
t值			-0.557	10.571		-1.070		24.593	-1.667		-15.758
P值			0.579	<0.01		0.287		<0.01	0.098		<0.01
组别		A-aDO₂(mmHg)					氧合指数(mmHg)
组别		治疗前			治疗后		治疗前			治疗后
观察组		40.26±3.17			28.32±3.03^*		244.03±7.61			301.65±9.21^*
对照组		39.86±3.97			35.55±2.46^*		246.80±8.71			280.98±4.90^*
t值		0.598			-14.074		-1.814			15.064
P值		0.551			<0.01		0.072			<0.01

组别	例数		SpO₂(%)			PaO₂(mmHg)			PaCO₂(mmHg)
组别	例数		治疗前	治疗后		治疗前		治疗后	治疗前		治疗后
观察组	57		89.89±1.84	95.84±1.77^*		62.41±1.72		82.45±2.91^*	48.01±3.28		37.29±0.88^*
对照组	58		90.10±2.17	92.84±1.23^*		62.80±2.19		70.89±2.06^*	48.86±2.04		41.10±1.06^*
t值			-0.557	10.571		-1.070		24.593	-1.667		-15.758
P值			0.579	<0.01		0.287		<0.01	0.098		<0.01
组别		A-aDO₂(mmHg)					氧合指数(mmHg)
组别		治疗前			治疗后		治疗前			治疗后
观察组		40.26±3.17			28.32±3.03^*		244.03±7.61			301.65±9.21^*
对照组		39.86±3.97			35.55±2.46^*		246.80±8.71			280.98±4.90^*
t值		0.598			-14.074		-1.814			15.064
P值		0.551			<0.01		0.072			<0.01

组别	例数	肺部感染发生率	肺部感染控制率
观察组	57	2(3.5)	22(38.6)
对照组	58	9(15.5)	12(20.7)
χ²值		4.792	4.427
P值		0.029	0.035