有创机械通气患者人工鼻最佳更换时间探讨  

Study on the best time to change artificial nose for invasive mechanical ventilation patients

作　　者：许海尔[1] 陈瑜[1] 陈密密[1] 王春英[1] 

机构地区：[1]浙江省宁波市第二医院,浙江宁波315000

出　　处：《护理与康复》2016年第2期110-113,共4页Journal of Nursing and Rehabilitation

基　　金：浙江省护理科学研究项目A类课题;编号:2012-A003

摘　　要：目的探讨有创机械通气患者应用人工鼻的最佳更换时间。方法将在综合ICU建立人工气道并采用CPAP模式进行机械辅助通气且应用人工鼻进行气道湿化管理的107例患者确立为研究对象,随机分为A、B、C、D 4组,更换人工鼻时间分别为24h、48h、72h和96h,观察并监测每组应用人工鼻期间患者日吸痰次数、痰液黏稠度、气道阻力、呼出气体相对温湿度、血气分析值变化,采集患者48h、96h及1周的痰标本进行细菌培养和涂片检查,判断有无呼吸机相关性肺炎的发生,同时对每日护理工作量进行统计。结果 4组患者使用人工鼻后的日吸痰次数、呼出气体相对温湿度、气道压,血气分析值及使用人工鼻后不同时间采集的痰细菌培养和涂片结果比较差异均无统计学意义(P>0.05),但C组痰液稀薄容易吸除例数占比大,有气道阻力患者占比小,与A组、B组、D组比较差异有统计学意义(P<0.05),护理工作量随着更换时间延长可相应减少。结论适当延长有创机械通气患者人工鼻的更换时间不会对患者造成负性影响,同时能减少护理工作量。Objective To study on the best time to change artificial nose for invasive mechanical ventilation patients. Method Divide 107 patients receiving airway humidifying management by artificial nose, set airway in comprehensive ICU and undergoing mechanical assisted ventilation by CPAP model into group A, B, C and D. Time to change artificial nose are 24h, 48h, 72h and 96h respectively. Observe and monitor the times of sputum suction every day, sputum viscosity, airway resistance, relative temperature and humidity of exhaled air and change of blood gas analysis of each group during application of artificial nose. Sputum specimens of 48h, 96h and 1 week are sent to bacterial culture and smear examination. Observe the occurrence of ventilator--associated pneumonia and figure out nursing workload. Result There is no significant differ- ence on times of sputum suction every day, relativetemperature and humidity of exhaled air, airway resistance, blood gas a- nalysis and result of bacterial culture and smear examination between 4 groups （P〉0. 05）. Rate of tenuity sputum is the highest and the less patients has airway resistance in group C, the difference is significant compared to group A, B, and D （P〈0. 05）. Nursing workload can be reduced with changing interval gets longer. Conclusion Expanding changing interval of artificial nose properly won＇t have any negative effect on invasive mechanical ventilation patients and can reduce nursing workload.

关 键 词：人工鼻 机械通气 更换时间 

分 类 号：R459.6[医药卫生—治疗学]