烧伤合并吸入性损伤患者气管套管外口多层纱布覆盖的保护作用探讨

Investigation on protective effects of multi-layer gauze covering the outer orifice of tracheal tube in burned patients combined with inhalation injury

目的:观察烧伤合并吸入性损伤患者气管套管外口使用多层纱布覆盖的保护效果。方法:40个培养皿分为1、2、3层纱布覆盖组及未覆盖组,每组10个,置同一病房同一平面24h后进行48h细菌培养,比较各组菌落数,以观察不同层数纱布对空气中细菌的滤过效果。选择烧伤合并吸入性损伤、气管切开、睡翻身床和悬浮床患者18例,用2层无菌纱布覆盖于气管套管外口,给氧管、湿化管穿过纱布网眼插入气管套管内,24 h后改用3层无菌纱布。以橡皮筋单圈或双圈捆绑将纱布和给氧管、湿化管固定在气管套管上,比较不同体位时橡皮筋单、双圈固定各层纱布和管道的牢固性,以及在仰卧位、自主呼吸情况下,2层或3层纱布覆盖气管套管外口后3～24 h患者的动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、动脉血氧饱和度(SaO_2)和经皮脉搏氧饱和度(SpO_2)的变化。结果:3、2、1层纱布覆盖及无纱布覆盖的培养皿内细菌菌落数分别为(17.6±2.0)株、(47.0±2.8)株、(60.4±3.3)株和(117.3±4.3)株,各组间比较差异有显著性(P<0.01)。橡皮筋单圈固定的各层纱布及管道仅在仰(侧)卧位且无咳嗽时不脱落。橡皮筋双圈固定纱布和管道在仰、侧、俯卧位伴用力咳嗽时均不脱落。2层或3层纱布覆盖气管套管外口,患者血气指标稳定在正常参考值范围内。结论:橡皮筋双圈固定纱布、管道的方法固定效果良好,使用3层纱布覆盖气管套管外口可以减少细菌侵入,且不影响患者O_2的摄入及CO_2排出。

Objective：To observe the protective effect of multi-layer gauze covering the outer orifice of tracheal tube in burned patients combined with inhalation injury. Methods： Forty bacteria culture plates were divided into 4 groups： 1-, 2-, 3-layer gauze-covered groups and uncovered group, with 10 plates in each group. They were placed on the same plane of the ward for 24 hours, and then bacteria were cultured for 48 hours and their colonies were counted, to observe the filtration effect of gauze in different layers in preventing penetration of bacteria suspended in air. In 18 burned patients with inhalation injury and tracheostomy kept on the stryker frame or air flotation bed, the outer orifices of tracheal tubes were covered with 2 layers of sterilized gauze, with oxygen and humidifying tubes inserted through the gauze, which was fixed by rubber band. After 24 hours, the two-layered gauze was changed into 3 layers. The reliability of fixation was compared with the patients in different posture. Changes in the partial pressure of oxygen in arterial blood （PaO2）, the partial pressure of carbon-dioxide in arterial blood （PaCO2）, the saturation of arterial oxygen （SaO2） and the saturation of percutaneous oxygen （SpO2） were observed during 3-24 hours while the patients were supine and free breathing. Results： The number of bacterial colonies was 17.6 4±2.0 on the 3-layer gauze-covered plates, 47.0 ± 2.8 on the 2-layer gauzecovered plates, 60.4 ± 3.3 on the 1-layer gauze-covered plates, and 117.3 ±4.3 on the uncovered plates. The differences in four groups were statistically significant （P〈0.01）. Fixed by rubber band in one circle, the gauzes and the tubes fell off except when the patients were in supine or lateral position, and without cough. When gauzes were fixed by rubber bands in two circles, the gauzes and the tubes did not fall off with patients lying in all postures and even there was forceful cough. The indexes of the PaO2, PaCO2, SaO2 and SpO2 were normal in all these patients. Conclusion：The method of fixation of rubber bands in two rounds is effective to prevent the gauze and tubes from falling off. When the tube opening is covered with three layers of gauze, bacterial invasion can be prevented without hindrance to respiration.