改良深部吸痰法在重型颅脑损伤气管切开患者中的应用  

Application of the Modified Deep Suction Methods for Patients with Severe Traumatic Brain Injuries Undergoing Tracheotomy

作　　者：毕娜[1,2] 王建荣[1] 

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

出　　处：《解放军护理杂志》2015年第12期6-9,共4页Nursing Journal of Chinese People's Liberation Army

基　　金：军队"十一五"面上课题(06MA051)

摘　　要：目的探讨改良深部吸痰法在重型颅脑损伤后气管切开患者中的应用效果。方法采用便利抽样法选择2013年6-10月解放军第309医院神经外科ICU收治的重型颅脑损伤后气管切开早期非机械通气患者40例,采用随机数字表法分为对照组和研究组。对照组采用常规吸痰法;研究组采取改良深部吸痰法,即在吸痰管尖端超过套管末端0.5cm时减慢插入速度,直至患者出现呛咳反射或感觉到气管隆凸阻力时吸痰。观察两组患者气道黏膜损伤情况、吸痰时患者屏气时间、人工气道通畅程度及临床肺部感染积分(clinical pulmonary infection score,CPIS)。结果两组患者气管切开后3、7d时的CPIS均高于气管切开前,差异有统计学意义(P<0.05);但3个时间点的组间比较差异无统计学意义(均P>0.05)。研究组吸痰时患者屏气时间短于对照组,气道黏膜损伤发生率低于对照组,差异均有统计学意义(P<0.01);两组患者人工气道通畅率差异无统计学意义(P>0.05)。结论改良深部吸痰法可以降低传统气管切开吸痰造成气管黏膜损伤的发生率,缩短吸痰时屏气时间,能够达到预防和减少肺内感染、保持呼吸道通畅的目的。Objective To discuss the application effect of modified deep suction in tracheotomy patients with severe traumatic brain injuries. Methods By convenience sampling, 40 cases with severe traumatic brain injuries undergoing tracheotomy were selected and divided as study and control group randomly. Patients in the control group followed the routine suction methods. Patients in the study group followed the modified deep suction methods, in which the speed of insertion tube reduced as the tip over the cannula tip 0.5 cm, until the reflection of tussis occurred or suction while feel the resistance in weasand. Bleeding and bronchoscopic status of airway mucosa, breath-hold time, patency of tracheotomy tube and CPIS were observed. Results The CPIS scores after third and seventh hour of tracheotomy were higher than them before the surgery in both groups （P〈 0. 05）,while there was no statistical significance among those three groups （all P〉0.05）.The breath hold time in study group was less than control group, and the incidence of injury of airway mucosa was less than which in control group （P 〈 0. 01）. The difference of patency rates of tracheotomy showed no statistical significance between two groups（P 〉 0. 05）. Conclusion Modified deep suction can reduce the injury of airway mucosa and the breath-hold time, help to reduce lung infection and maintaining patency.

关 键 词：重型颅脑损伤 气管切开 按需吸痰 指征 改良深部吸痰法 

分 类 号：R651.15[医药卫生—外科学]