改进密闭气道吸痰技术在重症肺炎患者中的应用

Application of Improved Closed Endotracheal Suction on Patients With Severe Pneumonia

目的对比密闭气道和改进密闭气道吸痰技术在重症肺炎患者中的应用效果。方法选取2013年1月—2014年1月天津医科大学总医院收治的17例机械通气超过24 h的重症肺炎患者,按照入院顺序单双号分为观察组9例和对照组8例。患者均采取按需吸痰的方式,对照组给予常规吸痰法,观察组给予试验改进的密闭气道吸痰技术,带管期间每天记录患者的第一次吸痰的情况。检测患者安全性指标:能否耐受,吸痰前及吸痰后的即刻心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp O2),有无气道黏膜损伤;效果指标:单次吸痰量,24 h吸痰次数及痰液总量,吸痰彻底情况;预后指标:气管插管时间,ICU入住时间。结果共记录121例次吸痰情况,其中对照组57例次,观察组64例次。两组患者吸痰前及吸痰后HR、MAP、Sp O2及吸痰耐受性、黏膜出血发生率比较,差异均无统计学意义(P>0.05)。两组24 h吸痰总量和痰鸣音得分比较,差异均无统计学意义(P>0.05);观察组单次吸痰量高于对照组,24 h吸痰次数少于对照组(P<0.05)。两组气管插管时间和ICU入住时间比较,差异均无统计学意义(P>0.05)。结论改进密闭气道吸痰技术安全性稳定,效果好,同时减少了临床护理的工作量,提高护士工作效率,减少了患者因吸痰操作而增加的恐惧感,达到了护患均满意,可在临床推广应用。

Objective To compare application effect of closed endotracheal suction method and improved closed endotracheal suction method of sputum suction on patients with severe pneumonia. Methods This study enrolled 17 patients with severe pneumonia who were admitted into the Tianjin Medical University General Hospital and received mechanical ventilation for more than 24 h from January 2013 to January 2014 and assigned them into observation group（ n = 9） and control group（ n = 8）according to odd and even number in admission order. Sputum suction was conducted when patients needed. Control group was treated with general sputum suction method, and observation group was treated with the closed endotracheal suction method improved by trials. During mechanical ventilation period,condition of first suction of each subject in each day was recorded.Indicators of safety were examined,including instant heart rate（ HR） and mean arterial pressure（ MAP）,oxygen saturation（ Sp O2） before and after suction,tolerability and damage of mucous membrane in airway; indicators of effect were examined,including amount of single sputum suction,the total amount and times of sputum suction in 24 h and thorough sputum sanction;indicators of prognosis were examined,including length of trachea cannula and length of stay in ICU. Results Conditions of 121 cases of suction were recorded,57 for control group and 64 for observation group. There were no significant differences between the two groups in the instant HR and MAP, Sp O2 before and after suction, tolerability and incidence of mucous membrane bleeding（ P〉0. 05）. There were no significant differences between the two groups in the total amount of sputum suction in 24 h and score in coarse rales（ P〉0. 05）. Observation group was higher than control group in amount of single sputum suction and lower than control group in the total times of sputum suction in 24 h（ P〈0. 05）. There were no significant differences between the two groups in length of trachea cannula and length of stay in ICU（ P〉0. 05）. Conclusion The improved method of closed endotracheal suction has a safe and steady effect. It reduces work amount in clinical nursing,improves work efficiency of nurses and also reduces the fear of patients for suction operation. This method can lead to the satisfaction of nurses and patients.Therefore,its clinical application should be promoted.