关键词: 结核, 肺, 通气机, 机械, 重症监护, 肺炎, 呼吸机相关性, 传染病护理

Abstract: Objective To investigate the effect of sequential sputum excretion scheme on pulmonary tuberculosis patients treated with mechanical ventilation.Methods Forty-five pulmonary tuberculosis patients with mechanical ventilation were selected as the experimental group from January to December 2018,and received sequential sputum excretion scheme;while 44 patients were recruited as the control group from January to December 2017 receiving routine sputum management. Breathing rate,mean arterial pressure,blood oxygen saturation,arterial oxygen partial pressure,artery oxygenation index,CO₂ partial pressure,airway peak pressure value,the amount of sputum drainage,effect of sputum excretion,incidence of ventilator-associated pneumonia,length of mechanical ventilation,length of ICU stay,and success rate of ventilator weaning were compared between two groups.Results After 24 hours of intervention,there was significant difference in breathing rate and no significant difference in mean arterial pressure fluctuation before intervention in two groups,but blood oxygen saturation,arterial oxygen partial pressure and oxygenation index in the experimental group were higher than those in the control group and before intervention（P<0.05）. After intervention,the peak airway pressure and arterial CO₂ partial pressure in the experimental group were significantly lower than those in the control group and before intervention（P<0.05）. After 24 hours of intervention,the daily sputum excretion in the experimental group（29.48±4.54） ml was significantly higher than the control group（12.56±2.287） ml（P<0.001）. After 7 days of intervention,the effect of sputum excretion in the experimental group was better than the control group（P<0.05）. Compared with the control group,the incidence of ventilator-associated pneumonia,the length of mechanical ventilation and the length of ICU stay in the experimental group were lower and shorter,and the success rate of ventilator weaning was higher（P<0.05）.Conclusion Sequential sputum excretion scheme can promote the discharge of sputum in pulmonary tuberculosis patients with mechanical ventilation,improve pulmonary function and quality of life,shorten length of stay in ICU and reduce medical burden.

Key words: Tuberculosis, Pulmonary, Ventilators, Mechanical, Intensive Care, Pneumonia, Ventilator-Associated, Communicable Diseases Nursing