集束化气道管理在重度吸入性损伤气管切开患者气道护理中的应用  

Application of bundle airway management in airway nursing of patients with severe inhalation injury after tracheotomy

作　　者：吴巍巍[1] 蔡夺[1] 迟骋[1] 马双[1] 武可[1] 李虹彦[2] 

机构地区：[1]吉林大学第一医院烧伤外科,长春130031 [2]吉林大学第一医院护理部,长春130031

出　　处：《中华现代护理杂志》2017年第34期4314-4318,共5页Chinese Journal of Modern Nursing

摘　　要：目的探讨集束化气道管理方法在重度吸入性损伤患者气道护理中的应用效果。方法将2013年6月—2014年12月吉林大学第一医院烧伤外科收治的32例重度吸入性损伤患者作为对照组，患者接受常规护理。将2015年1月—2016年6月收治的35例重度吸入性损伤患者作为观察组，患者按集束化气道管理方案实施护理，具体包括：气道评估及应急处理、窒息的发现及处理、体位管理、吸痰护理、声门下吸引、气道湿化、气囊管理、气管套管护理、气管切开部位护理、胸肺部护理、口腔护理、呼吸管路的管理、控制医疗环境感染。评价两组患者治疗第1、6、12天每日动脉血气分析指标（pH值、PaO2、PaCO2、血乳酸）、氧合指数、血氧饱和度（SaO2）；评价两组患者第2、3周时痰液黏稠度情况和痰培养阳性率。结果两组患者的pH值、PaO2、血乳酸、PaCO2和SaO2值在第6天比较，差异均有统计学意义（P〈0.05）；两组患者氧合指数在第12天比较，差异有统计学意义（P〈0.05）。第2、3周两组患者痰液黏稠度及痰培养阳性率比较，差异有统计学意义（P〈0.05）。结论应用集束化气道管理方法可有效提高吸入性损伤患者的氧合状态，改善患者痰液黏稠度，减少肺部感染的发生。ObjectiveTo explore the effects of bundle airway management on the airway nursing in patients with severe inhalation injury.MethodsTotally 32 patients with severe inhalation injury who were admitted and treated in the Department of Burns Surgery, the First Hospital of Jilin University between June 2013 and December 2014 were selected as a control group, who received conventional nursing, while another 35 patients with severe inhalation injury who were admitted and treated from January 2015 to June 2016 were selected as an observation group, who received nursing based on bundle airway management, including airway assessment and emergency treatment, diagnosis and treatment of suffocation, position management, sputum aspiration management, suction under glottis, airway humidification, aerocyst management, nursing with aircasing, nursing of incised part, nursing of breast and chest, mouth care, management of respiratory tube, and infection control in medical environment. Patients in the two groups were evaluated in arterial blood analysis indexes （pH, PaO2, PaCO2, Lac） , oxygenation index and oxygen saturation （SaO2） at day 1, 6 and 12; sputum density in week 2 and 3; and the number of cases with positive results in sputum cultivation in week 2 and 3.ResultsThere were statistically significant differences between the patients in the two groups in pH, PaO2, Lac, PaCO2 and SaO2 values at day 6 （P〈0.05） ; oxygenation index at day 12 （P〈0.05） ; and sputum density and the positive rate of sputum cultivation in week 2 and 3 （P〈0.05） .Conclusions Bundle airway management can effectively improve the oxygenation sputum density in patients with inhalation injury, and reduce their pulmonary infection.

关 键 词：烧伤 吸入性 气道管理 集束化 

分 类 号：R473.6[医药卫生—护理学]