气流冲击法对经口气管插管机械通气患者微误吸的预防效果研究  

Preventive effect of airflow shock on micro-aspiration of patients with mechanical ventilation via endotracheal intubation

作　　者：朱艳飞[1] 宋文静[1] 杨燕娣 王莹[1] 窦琳[1] Zhu Yanfei;Song Wenjing;Yang Yandi;Wang Ying;Dou Lin(Department of Critical Care Medicine,Tianjin First Central Hospital,Tianjin 300192,China;Department of Critical Care Medicine,Hetian District People′s Hospital,Xinjiang Uygur Autonomous Region,Hetian 848000,China)

机构地区：[1]天津市第一中心医院重症医学科,300192 [2]新疆维吾尔自治区和田地区人民医院重症医学科,848000

出　　处：《中国实用护理杂志》2020年第19期1486-1490,共5页Chinese Journal of Practical Nursing

基　　金：新疆维吾尔自治区科技支疆项目计划(2018E02102)。

摘　　要：目的探讨气流冲击法对经口气管插管机械通气患者微误吸的预防效果。方法采用单纯随机抽样法,选取2019年3-8月入住天津市第一中心医院重症监护室经口气管插管行机械通气的76例患者为研究对象,按照随机数字表法分为观察组和对照组各38例。观察组采用气流冲击法联合间断声门下滞留物吸引(SSD),对照组采用间断SSD,比较2组24 h囊上滞留物总量、囊上吸引管堵管发生率、囊上滞留物与下呼吸道分泌物细菌培养、呼吸机相关肺炎(VAP)发生率,并比较操作前后患者生命体征的变化。结果观察组VAP发生率、24 h囊上滞留物总量、囊上吸引管堵管发生率分别为2.9%(1/34)、(19.37±5.52)ml、17.6%(3/34),对照组分别为20.0%(7/35)、(14.98±3.77)ml、25.7%(12/35),2组比较差异有统计学意义(χ^2值为4.896、7.239,t值为5.315,P<0.05或0.01)。囊上滞留物培养病原菌阳性率为54.6%(113/207)、病原菌149株,下呼吸道分泌物病原菌阳性率为12.6%(26/207)、病原菌37株,2组囊上滞留物病原菌构成相似,以革兰阴性杆菌为主,主要优势菌为鲍曼不动杆菌、铜绿假单胞菌和嗜麦芽窄食单胞菌,2组囊上滞留物与下呼吸道分泌物主要病原菌构成比差异无统计学意义(P>0.05)。2组操作前后患者心率、收缩压、舒张压、呼吸变化比较差异无统计学意义(P>0.05)。结论气流冲击法联合间断SSD能有效清除气囊皱褶和集聚于囊上的滞留物,可减少囊上吸引管堵管发生率,预防微误吸的发生,降低VAP发生率。Objective To investigate the preventive effect of airflow shock on micro-smoke in patients with mechanical ventilation through oral tracheal intubation.Methods Using simple random sampling method,76 patients who underwent mechanical ventilation through oral tracheal intubation in Tianjin First Central Hospital from March 2019 to August 2019 were selected as subjects.They were divided into two groups by the random number table method with 38 cases in each group.The observation group was treated with airflow shock method and intermittent glottic suction.The control group was treated with intermittent glottic suction.The total amount of retentate on the 24 h capsule and the suction tube on the capsule were compared.The incidence of catheter blockage,bacterial culture of the upper respiratory tract and lower respiratory tract secretion,ventilator-associated pneumonia(VAP)incidence rate,and changes in vital signs of patients before and after operation.Results The incidence of VAP,the total amount of retentate on the 24 h capsule,the incidence of catheter blockage was 2.9%(1/34),(19.37±5.52)ml,17.6%(3/34)in the observation group,and 20.0%(7/35),(14.98±3.77)ml,25.7%(12/35)in the control group,the difference between the two groups was statistically significant(χ^2 values were 4.896,7.239,t value was 5.315,P<0.05 or 0.01).The positive rate of pathogens in the sac retentate culture was 54.6%(113/207),149 pathogens,the positive rate of lower respiratory tract secretion pathogen was 12.6%(26/207),and 37 pathogens.The pathogens of the two groups were similar.Gram-negative bacilli mainly,the main dominant bacteria were Acinetobacter baumannii,Pseudomonas aeruginosa and Stenotrophomonas maltophilia,and there was no significant difference in the ratio of the main pathogens in the sac retentate and lower respiratory tract secretions between the two groups(P>0.05).There was no significant difference in heart rate,systolic blood pressure,diastolic blood pressure and respiratory changes between the two groups before and after ope

关 键 词：抽吸 插管法 气管内 呼吸道误吸 机械通气 呼吸机相关肺炎 

分 类 号：R472[医药卫生—护理学]