脑外伤患者气管切开后不同黏稠度痰液适宜吸痰负压的临床研究

Study on the optimal suctioning negative pressure based on sputum viscosity in brain-injured patients with tracheotomy

目的研究颅脑外伤患者气管切开后不同黏稠度痰液的适宜吸引负压。方法以颅脑外伤后器官切开患者为研究对象,共43例。按照适时吸痰指征,根据患者痰液黏稠度选择不同吸引负压。Ⅰ度痰液:负压为13.3kPa、16.0kPa、20.0kPa和24.0kPa。Ⅱ度痰液:负压为20.0kPa、24.0kPa、26.7kPa和29.3kPa。Ⅲ度痰液:负压为26.7kPa、29.3kPa、33.3kPa和37.2kPa。测量每例患者吸痰前、吸痰后1min、3min、5min血氧饱和度(SpO2),并记录每次吸痰时间和黏膜损伤情况。结果Ⅰ度痰液在13.3-16.0kPa负压下吸痰,此时患者的SpO2下降幅度小,而且痰液吸净时间控制在25s左右;Ⅱ度痰液在24.0-26.7kPa负压下吸痰,此时患者的SpO2下降幅度小,而且痰液吸净时间控制在24-29s;Ⅲ度痰液在33.3kPa负压下吸痰,此时既可控制SpO2无显著下降,又保证痰液吸净时间在30s左右。结论根据痰液黏稠度选择不同负压吸痰,推荐Ⅰ度、Ⅱ度和Ⅲ度痰液分别使用13.3-16.0kPa、24.0-26.7kPa和33.3kPa。临床护士应根据痰液黏稠度不同,选择适宜的吸痰负压,做到同时控制SpO2的下降幅度和吸痰时间,最大限度降低吸痰导致的低氧血症和气道黏膜损伤。

Objective To determine the optimal suctioning negative pressure based on various sputum viscosity in brain-injured patients with tracheotomy. Methods Forty-three traumatic brain-injured patients with traeheotomy were recruited in the study. The negative pressure was determined based on the grade of sputum viscosity. Grade Ⅰ sputum was suetioned with the negative pressure of 13.3kPa,16.0kPa,20.0kPa and 24.0kPa, while Grade Ⅱ sputum with 20.0kPa,24.0kPa,26.7kPa and 29.3kPa,and Grade Ⅲ sputum with 26.7kPa,29.3kPa, 33.3kPa and 37.2kPa. The oxygen saturation（SpO2）was mon-itored before and 1min,3min,5min after endotracheal suctioning. At the same time,the suctioning time and tissue trauma were recorded. The data were analyzed by repeated measures analysis of variance with SPSS 13.0 software. Results The results showed that the optimal negative pressure was 13.3-16.0kPa for grade Ⅰ sputum,24.0-26.TkPa for grade Ⅱ sputum and 33.3kPa for grade Ⅲ sputum,which could ensure the minimum decrease of SpO2 and control the suctioning time within 25s or 30s respectively. Conchmion For traumatic brain-injured patients,various negative pressure should be selected based on the sputum viscosity by the clinical nurses when suctioning is performed,in order to avoid hypoxemia and tissue trauma caused by suctioning.