重型颅脑损伤患者气管切开吸痰指征的确定及评价

Confirmation and Evaluation of the Indicators of Tracheostomy Suction in Patients with Severe Brain Injuries

目的评价重型颅脑损伤后气管切开吸痰的时机。方法 2011年8月至2012年10月,便利抽样选择3所三级甲等医院神经外科ICU收治的符合研究条件的首次接受气管切开术的急性重型颅脑损伤患者36例。在术后第1天8:00开始进入实验研究,至第7天结束,观察并分析患者痰液黏稠度、痰液量、心率、呼吸、脉搏血氧饱和度、听诊痰鸣音、吸痰间隔时间、呼吸道湿化液量、咳嗽反射的变化情况,以及肺部影像学、支气管镜检查结果。结果 36例患者130例次气管切开吸痰临床资料Logistic回归结果显示,痰液量为因变量,自变量中是否出现自主咳嗽、氧饱和度变化值、呼吸道湿化液量、呼吸频率变化率、与肺部理疗间隔时间、听诊痰鸣音性质的偏回归系数有统计学意义(均P<0.05)。结论重型颅脑损伤气管切开患者吸痰指征推荐标准为:患者出现自主咳嗽;肺部听诊痰鸣音;肺部物理治疗后5.5 min之内;呼吸道湿化液量累计11.0 ml;脉搏氧饱和度值下降2.5%;呼吸频率增加17.65%;心率变化率达到患者基础心率的7.75%。

Objective To evaluate the indicators of tracheotomy suction for patients with severe traumatic brain injuries.Methods By convenience sampling,a total of 36 patients who received tracheostomy after severe brain injuries of 3 hospitals were enrolled in this study.The experimental study start in the 8： 00 of the first day,and ends in the seventh day.Factors involving viscosity and quantity of sputum,heart rate,change of breath rhythm,change of SpO2,rales,interval between suctions,moist liquid dose for airway,cough,image of lungs and bronchoscopic status were observed.Results Clinical data of 130 tracheostomy suctions Logistic regression showed that the sputum volume was the dependent variable,and the independent variables were the incidence of coughing,change of SpO2,tracheal humidity,changes of respiratory rate,interval of physical therapy for lungs,and rales（ P〈0.05）.Conclusion The main indications of tracheotomy suction for patient with severe traumatic brain injures are as follows： cough; rales; interval of physical therapy for lungs less than 5.5 min; the accumulative moist liquid dose for airway reaches 11.0ml; SpO2decreased by 2.5%; breath rate increase by 17.65%,and the heart rate reached the patient basic heart rate of 7.75%.