口腔颌面部肿瘤切除同期游离组织瓣移植修复术后保留经鼻气管插管患者鼻压力性损伤的预防研究  

Prevention of nasal pressure injury in patients with preserved nasal endotracheal intubation after oral and maxillofacial neoplasms resection and simultaneous free tissue flap transplantation

作　　者：刘瑞丽 臧娴娴[2] 白萍 郭雪凤 柴晓迎 刘亚 杨国勇[1] Liu Ruili;Zang Xianxian;Bai Ping;Guo Xuefeng;Chai Xiaoying;Liu Ya;Yang Guoyong(Department of Oral and Maxillofacial Surgery,Peking University School and Hospital of Stomatology,National Center of Stomatology,National Clinical Research Center for Oral Diseases,National Engineering Laboratory for Digital and Material Technology of Stomatology,Beijing 100081,China;Teaching Office,Peking University School of Nursing,Beijing 100191,China)

机构地区：[1]北京大学口腔医学院·口腔医院口腔颌面外科复苏室,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,北京100081 [2]北京大学护理学院教学办公室,100191

出　　处：《中华现代护理杂志》2021年第23期3130-3133,共4页Chinese Journal of Modern Nursing

基　　金：中华医学会杂志社2019年护理学科研究课题(CMAPH-NRI2019048)。

摘　　要：目的探讨口腔颌面部肿瘤切除同期游离组织瓣移植修复术后保留经鼻气管插管患者鼻压力性损伤的预防方法。方法采用便利抽样法,选取2018年8月—2019年12月在北京大学口腔医院行口腔颌面部肿瘤切除同期游离组织瓣移植修复手术的520例患者为研究对象,按照随机数字表法分为试验组和对照组。对照组采用常规护理;试验组使用丝绸布胶带偏离原压迫部位重新固定气管插管,异形充气气球支撑气管插管尾部。比较两组患者的鼻压力性损伤发生率、医用粘胶相关性皮肤损伤(MARSI)和气管插管固定问题导致的并发症发生情况。最终试验组246例患者、对照组248例患者完成研究。结果两组均未发生3期及以上的鼻压力性损伤。试验组患者经鼻气管插管相关的鼻压力性损伤发生率为2.85%(7/246),低于对照组的12.10%(30/248)(χ^(2)=15.254,P<0.001)。两组患者的MARSI发生情况比较,差异无统计学意义(P>0.05)。两组患者均未发生气管插管固定问题导致的并发症。结论采用丝绸布胶带重新固定气管插管,同时结合异形充气气球支撑气管插管尾部能够预防鼻压力性损伤,安全性较好。Objective To explore the preventive measures of nasal pressure injury in patients with preserved nasal endotracheal intubation after oral and maxillofacial neoplasms resection and simultaneous free tissue flap transplantation.Methods Using the convenient sampling method,a total of 520 patients who underwent oral and maxillofacial neoplasms resection and simultaneous free tissue flap transplantation in Peking University Hospital of Stomatology were selected as the research objects from August 2018 to December 2019.According to the random number table method,they were divided into the experimental group and the control group.Patients in the control group received routine care,while in the experimental group,silk surgical tape was used to re-fix the endotracheal intubation tube away from the original position,and the special-shaped inflatable balloon was used to support the remote end of the tube.The incidence of nasal pressure injury,medical adhesive-related skin injury(MARSI)and the occurrence of complications caused by the fixation of tracheal intubation of patients were compared between the two groups.In the end,246 patients in the experimental group and 248 patients in the control group completed the study.Results No stage 3 or above nasal pressure injury occurred in the two groups.The incidence of nasal pressure injury related to nasotracheal tube in the experimental group was 2.85%(7/246),lower than 12.10%(30/248)in the control group(χ^(2)=15.254,P<0.001).There was no statistically significant difference in the incidence of MARSI of patients between the two groups(P>0.05).No complications caused by endotracheal intubation fixation occurred in both groups.Conclusions The use of silk surgical tape to re-fix the endotracheal intubation and the combination of special inflatable balloon to support the end of the endotracheal intubation can prevent nasal pressure injury,and the safety is better.

关 键 词：插管法 气管内 压力性损伤 麻醉恢复室 预防 

分 类 号：R473.73[医药卫生—护理学]