开胸术后不同咳痰方式效果观察

Comparison of varied sputum expectoration methods in patients after thoracotomy

目的探讨开胸术后患者的最佳咳痰方法。方法将开胸手术患者176例随机分为四组各44例,分别给予自主咳嗽咳痰、指压咳痰(护士在患者锁骨上窝,或在环甲软骨处即喉结下方横行滑动按压气管)、雾化后自主咳痰、雾化后指压咳痰干预。结果四组日均呛咳、日均疼痛例次,咳痰有效率,3d例均咳痰总量比较,差异有统计学意义(均P<0.01)。结论自咳法疼痛率、呛咳率最低,但咳痰量也最少;指压法、雾化法或二者结合能取得较好效果。临床工作中应视患者情况及护理人力资源选择最佳的咳痰方式。

Objective To find the best way of sputum expectoration for patients after thoracotomy. Methods Totally, 176 patients after thoracotomy were divided into four groups, with each group having 44 cases： group A were asked to perform active cough and expectoration on voluntary basis; group B received induced sputum expectoration by nurses pressing the supraclavicuiar fossa or horizontally pressing the trachea below the cricoid cartilage in sliding motion; group C were asked to expectorate after atomization; group D received induced sputum expectoration with stimulation to supraclavicular fossa or the trachea below the cricoid cartilage after atomization. Results The counts of bucking coughs each day, daily counts of reports of pain greater than 3 points, rates of effective coughing, total volumes of sputum within 3 days in the 4 groups had significant differences （P〈0.01 for all ）. Conclusion Patients who were asked to perform active cough and expectoration on voluntary basis experienced least severe pain and had least bucking coughs, with least sputum being coughed up. Expectoration by finger pressing or atomization alone, or the combination of the two methods, can achieve excellent effect. Clinical nurses should help patients choose an optimal way to cough up sputum with considerations into patients＇ condition and availability of nursing human resources.