持续声门下分泌物稳压吸引技术的推广应用研究

Application and promotion of continuous aspiration of subglottic secretionby stabilized pressure suction technique

目的通过声门下分泌物稳压吸引技术的推广,提高本地区ICU患者声门下分泌物引流的效果,提高声门下分泌物管理质量。方法设计持续声门下分泌物稳压吸引器,并于2018年1—12月将持续声门下分泌物稳压吸引技术在浙江省7家医院进行推广,比较稳压吸引技术推广前后声门下分泌物引流的质量。每家医院将纳入的研究对象分为两组,声门下分泌物稳压吸引器材分别采用间歇吸引和持续吸引2种方法,间歇吸引组161例,持续吸引组160例,比较两组稳压器材减压孔堵塞、负压控制不稳发生率;比较吸引过程中分泌物的引流量、呛咳、吸引管堵塞和黏膜损伤发生率。结果推广后,7家医院的声门下吸引质量均有所提升,其中吸引操作和结果指标维度推广前后比较差异有统计学意义(P<0.05)。稳压器材性能方面,持续吸引组减压孔堵塞率(3.13%)高于间歇吸引组,负压控制不稳发生率(3.75%)低于间歇吸引组;声门下引流效果方面,持续吸引组声门下分泌物引流量为(53.55±5.92)ml/d,每日呛咳次数(3.01±1.13)次,均优于间歇吸引组,差异有统计学意义(t值分别为12.374、-2.625;P<0.05)。结论声门下分泌物稳压吸引器材性能良好,稳压吸引技术可有效提高引流效果;本研究推广的声门下分泌物稳压吸引器材推荐使用持续吸引的方法,对声门下分泌物引流质量的提高有显著作用,推广效应良好。

Objective Through the popularization of the technique of stabilized pressure suction of the subglottic secretion,to improve the drainage effect of subglottic secretion of intensive care unit(ICU)patients in this region,and to improve the quality of subglottic secretion management.Methods The stabilized pressure suction device on continuous aspiration of subglottic secretion was designed and the pressure-stabilized suction technique for subglotted secretion was promoted in 7 hospitals in Zhejiang province from January to December of 2018.The quality of drainage of subglottic secretion before and after the promotion of the stabilized suction technique were compared.In every hospital the included research objects were divided into two groups,and the subglottic secretion stabilized pressure suction devices adopted two suctioning methods of intermittent suction and continuous suction accordingly in the two groups:intermittent suction group(n=161)and continuous suction group(n=160),the incidence of blockage of decompression holes and instability of negative pressure control were compared between the two groups,and the incidences of drainage,cough,blockage of suction tube and mucosal injury during suction were compared.Results After promotion,the quality of subglotted secretion suctioning in 7 hospitals all improved,among which the dimensions of"suction operation"and"outcome indicator"showed statistically significant difference before and after promotion(P<0.05).In terms of the performance of stabilized pressure suction device,the blockage rate of decompression holes in continuous suction group(3.13%)was higher than that in intermittent suction group,and the incidence of negative pressure control instability(3.75%)was lower than that in intermittent suction group;in terms of the effect of subglottic drainage,the drainage flow rate of subglottic secretion in continuous suction group was(53.55±5.92)ml/d,and the daily coughing times were(3.01±1.13),both better than the intermittent suction group,the difference was statistically significant(t=12.374,-2.625;P<0.05).Conclusions Subglottic secretion pressure-stabilized suction device has good performance,and the technology of pressure-stabilized suction can effectively improve drainage effect.The method of continuous suction is recommended in this study,which has a significant effect on improving the drainage quality of subglottic secretion and has a good promotion effect.