加强呼吸道管理对吸入性损伤气管切开患者肺部感染的防治作用  

The preventive and therapeutic effect of advanced airway management on pulmonary infection in patients with inhalation injury after tracheotomy

作　　者：童亚林[1] 缪洪城[1] 冯小艳[1] 杨福旺[1] 朱金红[1] 龚震宇[1] 邓建军[1] 蒋晓臣[1] 朱富军[1] 辛海明[1] 

机构地区：[1]解放军第一八一医院烧伤整形科,广西桂林541002

出　　处：《中华烧伤杂志》2010年第1期6-9,共4页Chinese Journal of Burns

摘　　要：目的了解加强呼吸道管理措施对吸入性损伤气管切开患者肺部感染的防治效果。方法将笔者单位2000年1月-2004年12月收治的14例烧伤伴吸入性损伤患者设为对照组，予以常规全身治疗及常规呼吸道管理；2005年1月-2009年10月收治的27例烧伤伴吸入性损伤患者设为加强组，予以常规全身治疗并加强呼吸道管理，具体措施包括呼吸道“床边隔离”与双管（给氧管、湿化管）固定、体位“定向”湿化与痰液稀释、气道灌洗与程序式排痰、药物联合雾化治疗、“间断负压法”吸痰等。对比观察2组患者的痰液（气管切开后第7天）细菌培养结果、胸部X线片检查（入院后即刻和气管切开后第7天）结果、肺部感染情况、SO，和血气分析指标（气管切开后7d内）以及各组患者治愈率。结果（1）对照组患者中11例痰液细菌培养呈阳性占78．6％、加强组12例呈阳性占44．4％，组间比较，差异有统计学意义（χ^2=4．36，P〈0．05）。均以铜绿假单胞菌为主要检出菌。（2）胸部x线片提示，加强组7例患者发生肺炎占25．9％，明显少于对照组（8例，占57．1％，χ^2=3．87，P〈0．05）。肺部感染确诊结果与此一致。（3）2组患者观察期间均未出现CO2潴留现象，无窒息引起的PaC02、S02异常，PaC02值组间接近（t=0．89，P〉0．05）。（4）对照组治愈9例占64．3％，死亡5例，分别死于肺炎、创面脓毒症、MODS。加强组治愈25例占92．6％，死亡2例，死亡原因均为MODS。加强组治愈率明显高于对照组（χ^2=5．22，P〈0．05）。结论加强呼吸道管理措施对气道起到较好的滤过及隔离、湿化作用，便于痰液稀释、引流与排出，减少了盲目吸痰的概率与操作性损伤，有利于防治气管切开后继发的肺部感染。Objective To observe the preventive and therapeutic effect of advanced airway management on pulmonary infection in patients with inhalation injury after tracheotomy. Methods Fourteen burn patients with inhalation injury admitted to our hospital from January 2001 to December 2004 were enrolled as control （C） group, and they were treated with conventional systemic therapy and management of airway. Twenty-seven burn patients with inhalation injury admitted to our hospital from January 2005 to October 2009 were enrolled as advanced （A） group, and they were treated with conventional systemic therapy and advanced airway management, including bedside isolation of airway, fixation of both oxygen supply tube and humidifying tube, humidification in specific body position, thinning of sputum, lavement of airway and procedural sputum elimination, steam inhalation combined with medicine, and suction of sputum with interrupted negative pressure. Result of bacterial culture of sputum （the 7th day after tracheotomy） and chest X-ray （at admission and the 7th day after tracheotomy） , pulmonary infection, change in blood gas analysis index and oxygen saturation （ SO2 ） （within 7 days after tracheotomy）, and the number of patients cured in 2 groups were observed and compared. Results （1） Positive result of bacterial culture of sputum was observed in 11 （78.6%） patients in C group and 12 （44.4%） patients in A group. The difference between them was statistically significant （ χ^2 = 4.36, P 〈 0.05 ）. The main bacterium detected was Pseudomonas aeruginosa . （2） Pneumonia was suspected in 7 patients （25.9%） in A group by chest X-ray, which was obviously fewer than that in C group （8 cases, 57.1% , χ^2 = 3.87, P 〈0.05）. The result was in accord- ance with the diagnosis of pulmonary infection. （3） No CO2 retention, SO2 and PaCO2 abnormality caused by asphyxia was observed in 2 groups. PaCO2 value in A group was close to that in C group （ t =0.89, P 〉 0.05）. （4） In C gr

关 键 词：烧伤 吸入性 气管切开术 肺炎 呼吸道管理 

分 类 号：R473.6[医药卫生—护理学]