重型颅脑损伤气管切开患者按需吸痰指征应用现状调查  

Application current situation investigation of on the need sputum suction indications in severe traumatic brain injury patients undergoing tracheotomy

作　　者：毕娜 王建荣[2] 

机构地区：[1]解放军第三○九医院骨科中心,北京100091 [2]解放军总医院护理部,北京100853

出　　处：《中华现代护理杂志》2015年第32期3850-3854,共5页Chinese Journal of Modern Nursing

基　　金：军队“十一五”面上课题（06MA051）

摘　　要：目的：评价重型颅脑损伤气管切开患者吸痰指征应用现状。方法对北京、上海、福建、辽宁4个省市的75名护理专家和专科护士进行问卷调查。问卷调查的指征包括A类气道受阻导致血氧含量下降引起的症状或体征,B类气道分泌物聚集引起的肺部体征和患者的生理反应,C类护士气道管理过程中的护理行为3个方面的16项指征。调查项目包括目前临床使用频率、优先程度。结果目前临床使用频率分为3个档次,最高档次有4项,A类、C类指征各2项；第二档次有9项,其中A类指征3项,B类指征为4项,C类指征为2项；最低档次有3项,其中A类指征1项,B类指征为2项。优先程度分为分为3个档次,其中最高档次有4项,其中A类指征为3项,B类指征为1项；第二档次有10项,其中A类指征3项,B类指征为5项,C类指征为2项；最低档次有2项,均为C类指征。结论重型颅脑损伤气管切开患者按需吸痰指征目前临床使用的以A、C类指征为主。 B类指征是判断气道痰液聚集的最直接证据,需要通过相关培训提高护士评估能力,保证重型颅脑损伤气管切开患者按需吸痰效果。Objective To investigate the status quo of sputum suction when it is necessary in patients with traumatic brain injures undergoing tracheotomy. Methods Purposive sampling method was employed to select 75 nursing specialists and nurse specialism to investigate by questionnaire form Beijing, Shanghai, Fujian, Liaoning four citys and provinces. The indications of suction for patients with traumatic brain injures undergoing tracheotomy included three categories and 16 aspects indications as follows： category A was symptoms and signs caused by decreasing of blood oxygen when airway was obstructive; category B was pulmonary signs and physiological reactions caused by cohesion of airway secretions; category C was actions during the procedures of airway nursing. The investigation program included frequency of clinical use and priority. Results The current clinical use frequency had 3 levels with 4 items highest level （2 items in category A, 2 items in category C）; the second level had 9 items with 3 items in A category indication, 4 items in B category indication, 3 items in C category indication;the lowest level had 3 items with 1 in A category indication and 2 in B category indication. The priority was divided into three degree as well：the highest had 4 items with 3 items in A category indication and 1 in B category indication;the second degree had 10 items with 3 items in A category indication, 5 in B category indication and 2 items in C category indication;the lowest degree had 2 items with both in C category indication. Conclusions The category A and C indications of sputum suction are commonly used clinically in patients with traumatic brain injures undergoing tracheotomy, while category B indications is the direct evidence to judge sputum accumulation, so we should enhance nurses′ ability of evaluation to ensure the effects of sputum suction.

关 键 词：重型颅脑损伤 气管切开 按需吸痰 

分 类 号：R473.6[医药卫生—护理学]