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目的探讨咳嗽辅助仪(Cough Assist)用于清理神经肌肉疾病合并呼吸功能不全患者气道内分泌物的临床疗效。方法对46例神经肌肉疾病合并呼吸功能不全患者(气管插管机械通气患者34例、气管切开患者12例,其中吉兰-巴雷综合征患者24例、重症肌无力18例、多发性肌炎患者4例),采用随机数字表法随机分为A组(23例)和B组(23例)。其中A组患者使用咳嗽辅助仪清理呼吸道分泌物,B组患者使用机械振动排痰后采用吸痰管清理呼吸道分泌物。清理气道分泌物后,记录两组患者24 h内吸痰次数、患者氧合指数、肺静态顺应性及肺部感染率,同时记录吸痰后肺部听诊情况及胸部X线片显示结果。结果研究显示,咳嗽辅助仪能更充分清理患者呼吸道分泌物,明显改善患者的氧合指标、肺部听诊及肺部感染率,同时能减轻护理工作量。结论使用咳嗽辅助仪能有效清理神经肌肉疾病合并呼吸功能不全患者气道内分泌物,改善氧合,同时能减少肺部感染率及护理工作量,值得在临床推广。
Objective To investigate the clinical efficacy of Cough Assist in the clearance of airway secretions in patients with neuromuscular diseases and respiratory insufficiency. Methods 46 cases of neuromuscular diseases with respiratory insufficiency (tracheal intubation in 34 patients with mechanical ventilation, tracheotomy patients in 12 cases, including Guillain-Barre syndrome in 24 patients, myasthenia gravis 18 cases, multiple myopathy 4 patients with inflammation) were randomly divided into A group (23 cases) and B group (23 cases) by random number table. A group of patients using the Cough Assist to clean up respiratory secretions, B group using mechanical vibration sputum after sputum removal of respiratory secretions. After clearing the airway secretions, the number of sputum aspirates, oxygenation index, static compliance of the lungs and lung infection rate were recorded within 24 hours in both groups. Meanwhile, the auscultation of the lungs after sputum aspiration and the results of chest radiographs were recorded. Results The study showed that the Cough Assist instrument can more fully clear the respiratory secretions of patients, significantly improve the patient’s oxygenation index, pulmonary auscultation and lung infection rates, while reducing the workload of nursing. Conclusions The use of a cough assisting instrument can effectively clean the airway secretions in patients with neuromuscular diseases and respiratory insufficiency, improve oxygenation, and reduce lung infection rate and nursing workload, which is worthy of clinical promotion.