| Objective:To demonstrate the best effect of vibration sputum relaxation on promoting sputum excretion in patients with mechanical ventilation through oral endotracheal intubation after airway atomization with acetylcysteine solution.Methods:The test subjects were 281 patients admitted to the Department of Intensive Care Medicine of the Affiliated Hospital of Yan’an University with transoral tracheal intubation and mechanical ventilation from October 2020 to December 2021,and94 mechanically ventilated patients were selected according to the nadir criteria and randomly divided into groups A,B,C,and D using Excel,in the order of 0-10 min(A),10-20 min(B),20-30 min(C)and 30-40 min(D)after nebulizer treatment.Nebulised medication with acetylcysteine solution for inhalation and vibratory sputum relaxation with a high-frequency oscillatory sputum relaxation device,type G 2,000.The sputum was collected with respect to age,gender,BMI,primary diagnosis,and sputum properties,sputum volume,white blood cell count,C-reactive protein,oxygenation index,lung static compliance,atelectasis,partial pressure of carbon dioxide,and finger pulse oxygen saturation on the same day,3 days,and 7 days after treatment;mechanical ventilation(MV).Patients who were mechanically ventilated for more than 7 days Patients who were on mechanical ventilation for more than seven days were considered as the end point,while those who were on mechanical ventilation for less than seven days were considered as the end point at the time of last discharge from the ventilator.Results:1.The subject enrolled 94 patients who were intubated orally and mechanically ventilated,23 patients in group A,the age distribution was 45 years and 65 years,mean age 52.48±10.62 years,body mass index 23.87±1.82,14 males(60.87%);24 patients in group B,the age distribution was 36 years and 65 years,mean age 49.33±12.52 years,body mass index 22.87±1.56,19 males(79.17%);23 patients in group C,the age distribution was 36 years and 63 years,mean age 52.87±11.19 years,body mass index23.74±2.09,12 males(52.17%);24 patients in group D,the age distribution was 45years and 62 years,mean age 52.75±11.20 years,body mass index 23.50±1.83,13 males(54.17%).2.The results of the ANOVA test taken for the data of the measures showed that:The differences in peak airway pressure and plateau pressure between the four groups before treatment were not statistically significant,but the differences in peak airway pressure and plateau pressure between the four groups after treatment were statistically significant(P<0.05),suggesting that the increase in peak airway pressure and plateau pressure was the lowest when vibration was applied 20-30 min after inhalation of acetylcysteine solution.The patients had the lowest increase in peak airway pressure and plateau pressure when vibration was performed 20-30 min after airway nebulization with acetylcysteine solution.3.The results of the ANOVA test for the statistical analysis showed that:The changes in sputum indices(sputum viscosity,total sputum excretion)between the four groups of patients after airway nebulization inhalation with acetylcysteine solution for different time periods of vibratory sputum relaxation treatment were not statistically significant before and after treatment;however,the total sputum excretion and sputum viscosity increased with the prolongation of ventilator treatment in the intra-group comparison(P<0.05);However,the total amount of sputum excreted and sputum viscosity increased with the prolongation of ventilator treatment(P<0.05);the differences in blood gas indexes(oxygenation index and carbon dioxide partial pressure)between the four groups were not statistically significant before and after treatment;however,the oxygenation index decreased with the prolongation of ventilator treatment(P<0.05);the differences in inflammation indexes(WBC,PCT,CRP)between the four groups were not statistically significant before and after treatment.There was no statistically significant difference between the groups before and after treatment,but WBC and CRP decreased after treatment(P<0.05).4.Count dataχ~2 test showed that:Airway nebulized inhalation with acetylcysteine solution after different time periods of vibration loosening sputum,the incidence of pulmonary atelectasis was not statistically significant when compared between the groups of segments before and after treatment.Conclusions:It was performed 20-30 min after the acetylcysteine solution in invasive mechanical ventilation patients than in other time periods. |
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