神经外科ICU机械通气患者胃内容物误吸的危险因素分析  

Risk factors of aspiration of gastrointestinal contents in patients with mechanical ventilation in neurosurgical ICU

作　　者：李佳[1] 牛蓓蓓[1] 肖倩[2] 孙柳[1] 王军[3] 李桂云[4] 王艳玲[1] 

机构地区：[1]首都医科大学护理学院成人护理学学系教研室, 北京100069 [2]首都医科大学护理学院母儿护理学学系教研室, 北京100069 [3]首都医科大学宣武医院神经外科ICU, 北京100053 [4]首都医科大学附属北京天坛医院神经外科ICU, 北京100050

出　　处：《中华现代护理杂志》2017年第15期2041-2045,共5页Chinese Journal of Modern Nursing

摘　　要：目的 探讨神经外科ICU患者胃内容物误吸的高危因素,为临床预防误吸发生,减轻误吸并发症提供依据.方法 采用前瞻性队列研究设计、方便取样法收集北京市2所三级甲等医院神经外科ICU的机械通气患者资料74例,并通过检测气道分泌物中胃蛋白酶A的含量判断是否发生误吸.结果 74例患者误吸发生率为39.2%.经单因素分析得出胃内容物误吸的发生与床头抬高角度、肠内营养液泵入速度、胃管型号、胃潴留（GRVs）、重复插管、气囊压力、GCS评分、镇静剂有关（χ2/F值分别为30.771、16.845、11.471、9.212、6.582、15.664、11.722、18.312;P〈0.05）.进一步采用Logistic回归分析,误吸胃内容物的相关因素有5项,包括床头抬高角度、肠内营养液泵入速度、气囊压力、是否使用镇静剂和胃潴留（GRVs）.转换后的简易评分表的AUC为0.944,RR值为1.979（1.351,2.900）.简易评分表中得分≥10分者发生误吸胃内容的风险为得分〈10分者的2倍.结论 对于没有禁忌证的患者床头抬高〉30°气管插管的气囊压力维持在20-30 cmH2O;肠内营养液泵入鼻肠管的速度〈45 ml/h,鼻胃管速度〈25 ml/h,胃潴留（GRVs）≥50 ml的患者,建议使用鼻肠管进行肠内营养;关注使用镇静剂的患者,可降低胃内容物误吸的发生率.Objective To explore the high-risk factors of tracheobronchial aspiration of gastric contents of patients in Neurosurgical ICU, so as to provide basis for aspiration prevention as well as related complications.Methods The prospective cohort study was conducted during the patients with mechanical ventilation who were continuously enrolled. The general information and condition of 74 patients from two tertiary hospitals were recorded and their tracheal secretions were collected. The content of pepsin A in airway secretions was determined whether there is an aspiration.Results The incidence rate of aspiration in 74 patients was 39.2%. The chi-square test results showed that the angle of backrest elevation, the rate of enteral nutrition pump, diameter of nasogastric feeding tube, gastric residual volume, airbag pressure, Glasgow score and the use of sedatives were all related to the occurrence of aspiration （χ2/F =30.771, 16.845, 11.471, 9.212, 6.582, 15.664, 11.722, 18.312;P〈0.05）. Logistic regression analysis indicated five risk factors related to aspiration, including bed elevation angle, rate of enteral nutrition pump speed, airbag pressure, whether the use of sedatives and gastric residual volume. AUC of risk score calculation is 0.994,RR=1.979 （1.351,2.900）. The risk of patients whose AUC score≥10 was double of patients whose AUC score〈10.Conclusions To reduce the incidence of aspiration of gastric contents, for patients without contraindications, angle of backrest greater than 30 degrees, maintaining cuff pressure between 20 and 30 cmH2O, nasogastric feeding rate〈 25 ml/hour, small bowel feeding rate〈45 ml/hour, and GRVs ≥50 ml, gastric feedings and enteral nutrition are recommended; pay attention to patients usingsedative drugs, can also reduce the aspiration rate of gastric contents.

关 键 词：胃肠内容物 危险因素 神经外科 监护室 误吸 

分 类 号：R473.6[医药卫生—护理学]