摘要
目的探讨合理简化吸痰操作流程,实施改良吸痰法,对重症颅脑损伤气管切开术后肺部感染的预防效果。方法将60例重症颅脑损伤气管切开术后患者,按随机法分为改良方法组和传统方法组,每组均为30例。改良组吸痰前不试吸,发现患者有痰液堵塞,立即吸痰,保持呼吸道通畅,吸痰后用消毒液冲洗管道,暂停吸痰时吸引器接头浸泡于悬挂床头的消毒液瓶中。传统方法组用常规吸痰方法,吸痰前生理盐水试吸,吸痰后去除吸痰管,按常规在已经试吸过的生理盐水内冲洗管道。两组均应用两步吸痰法,即先用负压将气管导管内痰液吸净,然后按常规吸痰法吸气管深部的痰液。结果改良吸痰法与传统的吸痰法相比较,在两组吸痰指征相同的情况下,传统组吸痰所需时间为(121.67±0.70)s,改良组为(91.67±0.10)s,改良组吸痰所需时间低于传统组,差异有统计学意义(P<0.01),可节省时间约30 s;在患者指脉氧低于正常值且需要吸痰时,传统组吸痰后患者恢复Sp O2正常时间为(69.44±6.08)s,改良组为(42.78±0.49)s,改良组吸痰Sp O2恢复所需时间低于传统组,差异有统计学意义(P<0.01);但患者指脉氧为正常值且需要吸痰时,两组指脉氧恢复到吸痰前水平所需时间无明显差异性(P>0.05)。住院7 d内,传统组感染率为53.3%,改良组为23.3%,改良组肺部感染率较传统组低,差异有统计学意义(P<0.05);气道损伤、出血发生率,两组无明显差异性。结论改良吸痰法能赢得危重患者抢救时间,降低脑缺氧的发生,有效预防肺部感染,减少院内感染,节约资源和护理劳动力,改良吸痰法值得在临床推广。
Objective To evaluate the effect of the modified suction method for the prevention of patients who had picked up a pulmonary in- fection after tracheotomy resulting from severe craniocerebral injury.Methods 60 patients after tracheotomy with severe craniocerebral injury were randomly divided into two groups, modified group of 30 cases, and traditional group of 30 cases.Pre-suck was not carried out in the modi- fied group before aspiration of sputum. Once sputum blockage found in patients, the sputum was sucked immediately, and the airway kept unob- structed.After suction, the pipeline was flushed with disinfectant liquid, and the sputum aspirator was soaked in disinfectant liquid hanging be- side the bed. Routine application was used in the traditional group, in which saline was used for pre-sucking before sputum aspirating, and after sputum aspirating, the pipe was removed and flushed with disinfectant liquid.Both of the groups use the two-steps sputum suction method, at first sucking tracheal sputum completely with negative pressure, then sucking the deep tracheal sputum.Results Compared with the traditional group, the time of suction the traditional group need was（121.67±0.70） s, and the modified group was（91.67±0.10）s.The latter was less than the former（P〈0.01 ）.And the modified group can cut down on time for about 30S.As to the patients with finger pulse oxygen value below nor- mal and with indication of tracheal sputum sucking,the restored time of the finger pulse oxygen value of the traditional group was（ 69.44±6. 08 ）s, and the modified group was（42.78±0.49） s.The latter was less than the former（ P〈0.01 ）.But as to the patients with normal finger pulse oxygen value who also need tracheal sputum sucking, the restored time of the finger pulse oxygen value made no significant difference between the two groups.The rate of pulmonary infection within 7 days of hospitalization of the modified group was lower than that of the traditional group （P〈0.05） ,the former was 23.3%, and the latter was 53.3% ;and there was no significant difference between the two groups in airway injury and hemorrhage. Conclusion The modified suction method can gain the time in rescuing of the critical patients, lower the rate of cerebral an- oxia,prevent pulmonary infection efficiently, reduce hospital infection, save resources and nursing labor, and the nurses are willing to use the method in clinical practice.
基金
湖南省科技厅一般项目(项目编号:2011SK3097)
关键词
改良吸痰法
重型颅脑损伤
气管切开术
肺部感染
The Modified Suction Method
Severe Craniocerebral Injury
Traeheotomy
Pulmonary Infection
