围术期针对性气道护理管理在颅脑手术患者中的应用

Study on perioperative targeted airway care in patients with craniocerebral operation

目的探讨围术期针对性气道护理对颅脑手术患者血气分析、排痰效果及呼吸机相关肺炎(VAP)发生率的影响。方法选取在脑外科行手术治疗的76例重度颅脑损伤患者随机分为对照组和实验组各38例,对照组手术结束后予常规护理,实验组在常规护理基础上予针对性气道护理,观察并比较2组患者的p(O_2)、SaO_2、p(CO_2)、每日排痰量、吸痰次数、吸痰所需时间、ICU住院时间、病死率及不良反应发生率。结果第7天时,实验组p(O_2)及SaO_2水平高于第1天、p(CO_2)水平低于第1天,且实验组p(O_2)及SaO_2高于对照组、p(CO_2)低于对照组,差异有统计学意义(P<0.05);实验组每日排痰量多于对照组,吸痰次数及吸痰所需时间少于对照组,ICU住院时间少于对照组,病死率低于对照组,实验组VAP、堵管及痰痂形成的发生率低于对照组,差异均有统计学意义(P<0.05)。结论对重型颅脑损伤患者实施针对性气道护理,有助于提高氧分压及动脉血氧饱和度,降低二氧化碳分压,促进患者顺利排痰,减少ICU住院时间,降低病死率及不良反应发生率,值得临床推广应用。

Objective To investigate the effects of perioperative airway care on blood gas analysis,expectoration and ventilator-associated pneumonia( VAP) in patients undergoing brain surgery. Methods A total of 76 patients with severe craniocerebral injury undergoing surgical treatment in department of cerebral surgery were selected and randomly divided into two groups. A total of 38 cases in the control group were given routine nursing after the operation,and 38 cases in the experimental group was treated with routine nursing care on the basis of routine nursing. The levels of p( O_2),SaO_2,p( CO_2),daily sputum volume,sputum suction times,suction time,ICU time,mortality and the incidence of adverse reactions in hospital were observed. Results At 7 d,the levels of p( CO_2) and SaO_2 in the experimental group were higher,while the p( CO_2) level was lower than that at 1 d. Compared with the control group,the p( O_2) and SaO_2 levels of 7 d in the experimental group were higher,and the level of p( CO_2) was lower than that of the control group( P < 0. 05). The experimental group had more daily sputum volume,and less sputum suction times and suction time than the control group. The hospitalization time of ICU in the experimental group was less,and the mortality rate was lower,the incidences of VAP,tube blockage and sputum scab in the experimental group were lower than that in the control group,and the differences were statistically significant( P <0. 05). Conclusion Targeted nursing for patients with severe craniocerebral injury can improve the oxygen partial pressure and arterial oxygen saturation,reduce carbon dioxide partial pressure,promote the patients sputum excretion,reduce ICU hospitalization time,mortality,and incidence of adverse reactions,so it is worthy of clinical application.