改良气管切开切口换药方法的临床应用效果评价  

Application effect evaluation on modified incision dressing method in patients with tracheotomy

作　　者：邓秋霞[1] 王永红[1] 王丹丹[1] 贾志芳[1] 高岚[1] Deng Qiuxia;Wang Yonghong;Wang Dandan(The First Hospital of Jilin University,Jilin 130021 China)

机构地区：[1]吉林大学第一医院

出　　处：《护理研究》2018年第23期3712-3718,共7页Chinese Nursing Research

摘　　要：[目的]运用改良的切口换药方法,探讨其在气管切开病人中应用的临床效果,观察其对切口感染发生率、病人舒适度等方面的影响。[方法]选取2016年1月—12月吉林大学第一医院神经内科重症监护病房行气管切开并符合纳入标准的90例病人作为试验组,结合慢性伤口愈合理论制定改良切口换药方法,对病人实施改良的气管切开切口换药方法;选取同科室2015年1月—8月行气管切开并符合纳入标准的90例病人作为对照组,实施传统的气管切开切口换药方法。分别在病人气管切开后第1天(24h后)、第7天、第14天观察记录气管切口局部情况、气管切开切口感染发生率、病人舒适度、成本费用评价指标。[结果]切口局部观察指标比较:气管切开后第7天、第14天试验组切口局部情况优于对照组(P<0.01)。切口感染发生率:气管切开后第7天试验组切口感染发生率为4.4%,明显低于对照组(18.9%,P<0.05);气管切开后第14天试验组切口感染发生率为2.2%,明显低于对照组(14.4%,P=0.002)。病人舒适度比较:气管切开后第1天对照组舒适度评分为10.90分±2.01分,试验组为13.75分±2.11分;气管切开后第7天对照组舒适度评分为12.06分±1.81分,试验组为16.28分±1.89分;气管切开后第14天对照组舒适度评分为14.46分±1.54分,试验组为17.77分±1.52分,两组比较,试验组病人舒适度评分均高于对照组(P<0.01)。成本费用比较:对照组病人日均换药频次(中位数)为3次,试验组为2次;对照组病人日均换药时间为(12.72±1.44)min,试验组为(10.84±0.89)min(P<0.001);对照组病人日均换药成本为(17.00±1.06)元,试验组为(23.83±1.01)元(P<0.001)。[结论]改良切口换药方法在气管切开病人中应用的临床效果较好,可降低气管切口感染发生率,提高气管切开病人的护理质量,并改善病人的舒适度。Objective：To improve the clinical application of the modified incision dressing method in patients with a tracheotomy,and to observe its influence on the incidence of wound infection and patients＇ comfort. Methods：A total of 90 patients who underwent tracheotomy in the neurology intensive care unit （ICU） in the First Hospital of Jilin University from January to December 2016 and meeting the inclusion criteria were selected as the experimental group, and the modified incision dressing method was developed in combination with the theory of chronic wound healing. A modified tracheotomy incision dressing method was performed on the pa tient ;another 90 patients who underwent tracheotomy in the same department from January to August E015 and met the inclusion criteria were selected as the control group ,and the traditional tracheotomy incision dressing method was implemented. The local condi tions of the tracheal incision, the incidence of tracheotomy infection,patientts comfort,and expense were recorded on the first day （21 h after） ,the 7th day,and the 14th day after tracheotomy. Results：Comparison of local observation indexes of incision：on the 7th and l dth day after tracheotomy,the local incision of patients in the experimental group was better than that in the control group （P〈0. 001）. The incidence of wound infection：the incidence of wound infection in the experimental group was 4.4% on the 7th day after tracheot omy,which was significantly lower than that in the control group （18.9% ,P〈0.05）. The incidence of wound infection in the experi mental group on the l dth day after tracheotomy was 2.2% ,which was significantly lower than that of the control group （14.4% ,P =0.002）. Comparison of patientts comfort：on the first day after tracheotomy,the comfort score in control group was （10.90±2. 01） , in the experimental group was （13.75±2.11）,and the comfort score in control group scored （12. 06±1.81） on the 7th day after tracheotomy. The score in the experimental

关 键 词：气管切开 切口护理 慢性伤口 换药 换药流程 切口感染 舒适度 

分 类 号：R473[医药卫生—护理学]