应用Delphi法构建重型颅脑损伤气管切开按需吸痰指征指标  

Establishment of demand-based sputum suction indications after tracheotomy by Delphi method for patients with severe brain injuries

作　　者：毕娜[1,2] 王建荣[1] 

机构地区：[1]解放军总医院护理部,北京市100853 [2]解放军第309医院骨科中心,北京市100091

出　　处：《护理管理杂志》2014年第10期685-687,共3页Journal of Nursing Administration

基　　金：军队"十一五"面上课题(06MA051)

摘　　要：目的 构建重型颅脑损伤气管切开按需吸痰指征指标体系,为按需吸痰提供依据.方法 选取7个省市11所医院的40名医疗护理专家为咨询专家,对经文献检索初步筛选的3类25项重型颅脑损伤气管切开按需吸痰指征进行3轮函询.结果 专家权威系数为0.90,3轮问卷有效回收率为85.00％ 、91.18％ 、100.00％.第3轮咨询结束后,听诊有痰鸣音、脉搏氧饱和度下降、自主咳嗽、呼吸频率变化率、上一次吸痰时痰液黏稠度、气道湿化液量、吸痰与肺部物理治疗间隔时间、与上次吸痰间隔时间、心率变化率这9个指征的重要性＞4,变异系数0.06 ～0.18.结论 专家推荐听诊有痰鸣音、脉搏氧饱和度下降、自主咳嗽、呼吸频率变化率、上一次吸痰时痰液黏稠度、气道湿化液量、吸痰与肺部物理治疗间隔时间、与上次吸痰间隔时间、心率变化率为重型颅脑损伤气管切开患者按需吸痰指征指标,此指标具有科学性、可靠性和针对性.Objective To establish the sputum suction indication system after tracheotomy for patients with severe brain injuries, and provide basis for demand - based suction. Methods Forty specialists in 11 hospitals were selected as consultants for 3 rounds expert consultation. The 25 sputum suction indications were screened by the experts. Results The authority coefficient was 0.90. The recovery rates of questionnaires at three rounds were 85.00% ,91.18% and 100.00%. After three rounds of consultation, the importance scores of roles, decrease of SpO2 , independent cough, change of breath rate, viscosity of sputum, moist liquid dose for airway ,time of physiotherapy for pulmonary, time of previous suction and change of HR were 〉 4, the CV ranged from 13.06 to 0. lg. Conclusion Factors involving rales, decrease of SpO2 , independent cough, change of breath rate, viscosity of sputum, moist liquid dose for airway, time of physi- otherapy for pulmonary, time of previous suction, change of HR are suggested to be indications of tracheotomy suction for patients with severe brain injuries.

关 键 词：重型颅脑损伤 气管切开 吸痰 指征 

分 类 号：R473.6[医药卫生—护理学]