督导式预警性护理在神经外科气管切开非机械通气重度昏迷患者气道管理中的应用  

Application of supervised early warning nursing in airway management of severe coma patients with tracheotomy and non-mechanical ventilation in neurosurgery department

作　　者：胡燕莹 王萍[1] Hu Yanying;Wang Ping(Neurosurgery Department,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属第一医院神经外科,杭州310000

出　　处：《中国实用护理杂志》2023年第25期1955-1960,共6页Chinese Journal of Practical Nursing

摘　　要：目的探讨督导式预警性护理在神经外科气管切开重度昏迷患者预防肺部感染中的应用效果,为提高神经外科重症昏迷患者的临床实践管理水平提供借鉴和参考。方法采用临床对照试验,便利选取2022年3—10月浙江大学医学院附属第一医院神经外科的气管切开非机械通气重度昏迷患者共58例,采用随机数字表法将患者分为对照组与试验组各29例,对照组实施常规护理,试验组在常规护理基础上实施督导式预警性护理干预,观察并比较2组的肺部感染、气道黏膜损伤及痰液性状。结果干预后试验组肺部感染发生率为34.5%(10/29),低于对照组的62.1%(18/29);试验组气道黏膜损伤发生率为10.3%(3/29),低于对照组的34.5%(10/29),差异均有统计学意义(χ^(2)=4.42,4.86,均P<0.05)。干预后试验组痰液性状为Ⅰ度、Ⅱ度、Ⅲ度者分别为4、23、2例,对照组分别为2、10、17例,差异有统计学意义(Z=-2.85,P<0.05)。结论将督导式预警性护理应用于气管切开非机械通气重度昏迷患者的气道管理中,能有效控制肺部感染的发生,改善痰液性质,对改善患者预后有重要意义。Objective To explore the effect of supervised early warning nursing in the prevention of pulmonary infection in severe coma patients with tracheotomy in neurosurgery department,so as to provide reference for improving the clinical practice management level of severe coma patients in neurosurgery department.Methods A clinical controlled trial was conducted.From March to October,2022,58 severe coma patients with tracheotomy and non mechanical ventilation who were admitted to the neurosurgery department of the First Affiliated Hospital of Zhejiang University School of Medicine were selected by convenient sampling method.The patients were randomly divided into control group(29 cases)and experimental group(29 cases).The control group received routine nursing.The experimental group implemented supervised early warning nursing based on routine nursing.The pulmonary infection,airway mucosal injury,sputum characteristics of the two groups were observed and compared.Results After intervention the incidence of pulmonary infection in the experimental group was 34.5%(10/29),which was lower than 62.1%(18/29)in the control group;the incidence of airway mucosal injury in the experimental group was 10.3%(3/29),which was lower than 34.5%(10/29)in the control group.The differences were statistically significant(χ^(2)=4.86,4.42,both P<0.05).After intervention,there were 4,23,and 2 cases with sputum characteristics ofⅠdegree,Ⅱdegree,andⅢdegree in the experimental group,and 2,10,and 17 cases in the control group,respectively.The difference was statistically significant(Z=-2.85,P<0.05).Conclusions The application of supervised early warning nursing in airway management of severe coma patients with tracheotomy and non mechanical ventilation can effectively control the occurrence of pulmonary infection,improve sputum characteristics,which possesses important significance on the prognosis of patients.

关 键 词：气管切开术 督导式预警性护理 气道管理 

分 类 号：R473.6[医药卫生—护理学]