持续声门下吸引联合间断声门下灌洗在清除经口气管插管患者气囊上滞留物中的应用  

The application of continuous subglottic suction combined with intermittent subglottic lavage to the removal of subglottic secretion in the patients undergoing orotracheal intubation

作　　者：姚敏[1] 包芸[2] 沈丽娟[3] 姬文华[1] 徐巍[1] YAO Min;BAO Yun;SHEN Lijuan;JI Wenhua;XU Wei(Intensive Care Unit,the First People's Hospital of Huzhou City in Zhejiang Province,Huzhou313000,China;Emergency Care Unit,the First People's Hospital of Huzhou City in Zhejiang Province,Huzhou313000,China;Department of Nursing,the First People's Hospital of of Huzhou City in Zhejiang Province,Huzhou313000,China)

机构地区：[1]浙江省湖州市第一人民医院重症医学科,浙江湖州313000 [2]浙江省湖州市第一人民医院急诊监护室,浙江湖州313000 [3]浙江省湖州市第一人民医院护理部,浙江湖州313000

出　　处：《中国现代医生》2020年第26期171-175,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划(2018KY776)。

摘　　要：目的研究持续声门下吸引联合间断声门下灌洗清除气囊上滞留物对经口气管插管患者呼吸机相关性肺炎(Ventilation associated pneumonia,VAP)的影响。方法选择2015年1月~2017年10月在我院综合ICU病房机械通气(Mechanical ventilation,MV)>48 h的80例经口气管插管患者,分为试验组和对照组两组,每组40例。对照组采用常规间断声门下吸引法清除囊上滞留物,试验组采用持续声门下吸引联合间断声门下灌洗法清除囊上滞留物。比较两组患者囊上滞留物吸引量、VAP发生率、呛咳、囊上分泌物含菌量、气道黏膜受损出血及吸引管堵塞情况。结果试验组患者的VAP总发生率较对照组明显降低,差异有统计学意义(χ2=14.459,P=0.000);试验组患者囊上分泌物分离出细菌数较对照组明显降低,差异有统计学意义(Z=2.552,P=0.011);试验组患者呛咳、吸引管堵塞发生率较对照组降低,差异均有统计学意义(P<0.05),试验组囊上滞留物吸引量平均为(52.23±7.08)mL/d,较对照组(45.02±7.27)mL/d明显增多,差异有统计学意义(P<0.05);两组患者肉眼可见血性液体、隐血试验阳性发生率比较,差异无统计学意义(P>0.05)。结论对经口气管插管机械通气的患者采取持续声门下吸引联合间断声门下灌洗法较常规吸引法更有效清除气囊上滞留物,进而减少呛咳、吸引管堵塞相关并发症,降低VAP发生率,值得在临床上推广使用。Objective To study the effect of continuous subglottic suction(CSS)combined with intermittent subglottic lavage to remove subglottic secretion on ventilator-associated pneumonia(VAP)of the patients undergoing orotracheal intubation.Methods A total of 80 orotracheal intubation patients who underwent mechanical ventilation(MV)for more than 48 h in the comprehensive ICU ward of our hospital from January 2015 to October 2017 were selected and divided into the experimental group and the control group with 40 patients in each group.The control group was treated with conventional intermittent subglottic suction to remove subglottic secretion,while the experimental group was treated with CSS combined with intermittent subglottic lavage to remove subglottic secretion.The two groups of patients were compared in terms of the amount of subglottic suction drainage,the incidence rate of VAP,choking cough,bacteria content in subglottic suction,airway mucosa damage and hemorrhage,and drainage tube blockage.Results The total incidence of VAP in the experimental group was significantly lower than that in the control group,and the difference was statistically significant(χ2=14.459,P=0.000).The amount of bacteria isolated from subglottic secretion of the patients in the experimental group was less than that in the control group,and the difference between the two groups was statistically significant(Z=2.552,P=0.011).The incidence of choking cough and suction tube blockage in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05);the average amount of subglottic suction drainage in the experimental group was(52.23±7.08)mL/d,which was significantly higher than(45.02±7.27)mL/d in the control group,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in the incidence of bloody fluid visible to the naked eye and positive result of occult blood test(P>0.05).Conclusion CSS combined with intermittent subglottic

关 键 词：声门下吸引 声门下灌洗 经口气管插管 呼吸机相关性肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]