大面积烧伤合并吸入性损伤患者气管切开术后吸痰的护理  

Sputum suction nursing on large area burn patients with inhalation injury after tracheotomy

作　　者：王淑君[1] 申传安[1] 李菊清[1] 李大伟 李方容[1] 柳聪影 

机构地区：[1]解放军总医院第一附属医院烧伤整形科,北京100048 [2]解放军医学院,北京100853

出　　处：《中华现代护理杂志》2013年第31期3873-3875,共3页Chinese Journal of Modern Nursing

摘　　要：目的 探讨大面积烧伤合并吸入性损伤患者气管切开术后的更佳吸痰护理模式.方法 选取烧伤面积≥30％,年龄18 ～60岁,合并中、重度吸入性损伤,行气管切开术的患者作为研究对象,选取2009年1月至2010年10月收治患者作为传统吸痰组,2010年11月至2012年9月收治患者作为改进吸痰组.传统吸痰组按照医疗护理技术操作常规实施吸痰,将一次性吸痰管插入气道一定深度,打开负压,吸痰管自下慢慢上提,并左右旋转,以吸尽痰液;吸痰时机为按需和适时吸痰.改进吸痰组为有计划分次分段吸痰,第1次吸尽气管套管内的痰液,根据气管套管的规格号数计算吸痰管插入长度;第2次为更换吸痰管后,打开负压,插入吸痰管至气管隆突上1～2 cm,边捻搓吸痰管边上提;吸痰时机为行雾化吸入后,叩背或震动排痰毕进行,6～8次/d.结果 改进吸痰组肺部感染率为30.43％,传统吸痰组为82.35％,两组比较差异有统计学意义（x2=15.604,P＜0.01）.结论 雾化吸入、叩背后有计划定时分段分次进行边捻搓边退吸痰管的吸痰护理方式优于按需适时传统吸痰护理,可以有助降低大面积烧伤合并吸入性损伤患者气管切开术后的肺部感染率.Objective To explore a better sputum suction nursing model on the large area burn patients with inhalation injury patients after tracheotomy. Methods Patients with bums area I〉30% aged 18-60 years, moderate or severe inhalation injury and tracheotomy were included. The patients in the traditional sputum suction group were chosen from January 2009 to October 2010, and received the sputum suction nursing according to the medical nursing technical operation, specific process was as follows： the disposable sputum suction tube was inserted into the airway in certain depth, was slowly lifted from the bottom, and was rotated around in order to completely suck up sputum; and the sputum suction time was on-demand timely. The patients in the improved sputum suction group were chosen from November 2010 to September 2012, and received the planned sputum suction, and the sputum in the tracheal cannula were sucked up for the first times, the length of suction tube insertion was calculated according to the specification of tracheal cannula; the sputum suction tube was changed at the second time, and was inserted into 1-2 cm above tracheal carina; the sputum suction time was after inhalation, call-back or vibration row phlegm, 6-8 times/d. Results The pulmonary infection rate in the improved sputum suction group was 30. 43%, and 82.35% in the traditional sputum suction group, and the difference was statistically significant （ X2 = 15. 604, P 〈 0. 01 ）. Conclusions The improved sputum suction nursing method which was planned, inhalation, call-back, ere, is better than the traditional sputum suction, and it is helpful to reduce the pulmonary infection rate in large area bum patients with inhalation injury after traeheotomy.

关 键 词：烧伤 气管切开术 吸入性损伤 吸痰技术 肺部感染 

分 类 号：R473.6[医药卫生—护理学]