ICU患者人工气道内痰痂堵管的发生率及影响因素分析

Incidence and Impact Factors of Sputum Crust Obstruction in ICU Patients Undergoing Artificial Airway

【目的】探讨ICU不同方式建立人工气道患者痰痂堵管的发生率及影响因素。【方法】选择2015年1月～12月本院收治的危重症患者621例，建立人工气道治疗24h以上，患者给予原发病治疗及临床标准气道护理，比较气管插管与气管切开患者人工气道内痰痂堵管发生率，多因素logistic回归分析人工气道内痰痂堵管发生的危险因素。【结果】621例重症患者中人工气道内痰痂堵管发生率为9．02％（56／621），其中气管插管痰痂堵管发生率为8．49％（46／542），与气管切开12．66％（10／79）比较无统计学差异（x2=1．4621，P=0．23）；重型颅脑外伤、慢性阻塞性肺病（COPD）患者痰痂堵管发生率较高，分别为12．39％、9．60％；咳嗽反射消失、合并肺部感染、误吸、带管时间长、无有效气道湿化、气道出血为人工气道内痰痂堵管的独立危险因素（P〈0．05）。【结论】痰痂堵管为ICU人工气道患者常见临床并发症，对于重型颅脑外伤、COPD患者需加强预防护理，有效控制预防高危因素及实施相应的护理，有利于降低人工气道内痰痂堵管的发生。

[Objective] To investigate the incidence and impact factors of sputum crust obstruction in ICU patients underwent artificial airway. [Methods] A total of 621 ICU patients underwent artificial airway over 24h in the hospital from January 2015 to December 2015 was selected. Patients were treated with primary disease treatment and clinical standard airway care so as to compare the incidence rate of sputum crust in patients with artificial airway under tracheal intubation and tracheotomy. Multivariate logistic regression analysis was used to confirm the risk factors for the occurrence of intra sputum crust in artificial airway. [Results] The incidence of sputum crust obstruction in 621 ICU patients underwent artificial airway was 9.02% （56/621）. The incidence of sputum crust obstruction in endotracheal intubation and tracheotomy was 8.49% （46/542）, 12.66 % （10/79） respectively, there was no statistical difference （x2= 1.4621, P = 0.23）. Patients with severe traumatic brain injury and COPD showed higher incidence of sputum crust obstruction as 12.39 % and 9.60%. Cough reflex disappearance, complicated pulmonary infection, mis-aspiration, long-time piped , no effective airway humidification and airway bleeding were independent risk factors for the blockage of sputum in artificial airway（ P 〈0.05）.[Conclusion] Sputum crust obstruction is a common clinical complication in ICU patients underwent artificial airway. Patients with severe traumatic brain injury and COPD are needed to strengthen preventive care. Effective prevention of risk factors and nursing help to reduce the incidence of sputum crust obstruction in ICU patients undergoing artificial airway.