摘要
目的 探讨二氧化碳调节罩对气管切开术后呼吸性碱中毒患者血气指标、脑氧代谢的影响.方法 选取2020 年1 月—2023 年 1 月收治的 50 例气管切开术后呼吸性碱中毒患者,据干预方法分为观察组和对照组,每组25 例.观察组使用二氧化碳调节罩固定于面部行腹式呼吸,对照组使用传统纸袋罩住口鼻行腹式呼吸.比较2 组临床疗效与症状完全缓解时间;2 组气管切开前(T1)、气管切开后10 min(T2)、气管切开后30 min(T3)、术毕(T4)时血气指标[动脉血二氧化碳分压(PaCO2)、细胞外液碱剩余(BEecf)、实际碳酸氢盐(AB)、总二氧化碳]、循环指标[平均动脉压(MAP)、心率(HR)、呼吸频率(RR)]、脑氧代谢指标[脑动静脉血氧含量差(Da-jvO2)、脑氧摄取率(CERO2)]、氧化应激指标[髓过氧化物酶(MPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)]水平.结果 观察组临床总有效率高于对照组(P＜0.01).观察组症状完全缓解时间为(32.27±10.62)min短于对照组的(154.23±40.16)min(P＜0.01).2 组T2 时PaCO2、BEecf、AB、总二氧化碳、SOD均较T1 时明显下降,T3～T4 时均较T2 时升高,对照组T3～T4时低于T1 时,观察组T3～T4 时高于对照组(P＜0.05).2 组T2 时MAP、HR、RR、Da-jvO2、CERO2、MPO、MDA均较T1时明显升高,T3～T4 时均较T2 时下降,对照组T3～T4 时高于T1 时,观察组T3～T4 时低于对照组(P＜0.05).结论 气管切开后呼吸性碱中毒患者使用二氧化碳调节罩可提高临床疗效,加快改善临床症状,促使血气循环更加平稳,纠正脑氧代谢异常状态,有助于减轻机体氧化应激损伤.
Abstract
Objective To investigate the effects of carbon dioxide mask on blood gas indexes and cerebral oxygen me-tabolism in patients with respiratory alkalosis after tracheotomy.Methods Fifty patients with respiratory alkalosis after trach-eotomy treated from January 2020 to January 2023 were selected and divided into observation group(n =25)and control group(n =25)according to intervention methods.The observation group used carbon dioxide mask fixed on the face for abdominal breathing,and the control group used traditional paper bag covering the mouth and nose for abdominal breathing.The clinical effect and the time of complete remission of symptoms were compared between the two groups.Blood gas indexes[arterial par-tial pressure of carbon dioxide(PaCO2),base excess extracellular fluid(BEecf),actual bicarbonate(AB),total carbon di-oxide],circulation indexes[mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR)],cerebral oxygen me-tabolism indexes[cerebral arterio-venous oxygen content difference(Da-jvO2),cerebral oxygen uptake rate(CERO2)],and oxidative stress indexes[myeloperoxidase(MPO),malondialdehyde(MDA),superoxide dismutase(SOD)]levels before tracheotomy(T1),at 10 min after tracheotomy(T2),at 30 min after tracheotomy(T3),and immediately after operation(T4)were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group(P＜0.01).The time to complete remission of symptoms in the observation group was(32.27±10.62)min,which was shorter than that in the control group[(154.23±40.16)min](P＜0.01).PaCO2,BEecf,AB,total carbon dioxide and SOD in the two groups were significantly lower at T2 than at T1,and higher at T3-T4 than at T2,which were lower at T3-T4 than at T1 in the control group,and higher at T3-T4 in the observation group than in the control group(P＜0.05).MAP,HR,RR,Da-jvO2,CERO2,MPO and MDA in the two groups were significantly higher at T2 than at T1,and lower at T3-T4 than at T2,which were higher at T3-T4 than at T1 in control group,but lower at T3-T4 in the ob-servation group than in the control group(P＜0.05).Conclusion The use of carbon dioxide mask in patients with respirato-ry alkalosis after tracheotomy can improve the clinical effect,accelerate the improvement of clinical symptoms,promote more stable blood gas circulation,correct the abnormal state of cerebral oxygen metabolism,and help alleviate the oxidative stress injury of the body.
基金项目
吕梁市科技重点研发项目(2018shfz64-7)
国家科技期刊平台
NSTL
万方数据