吸痰深度标定对预防老年机械通气患者气道黏膜损伤的效果评价

Effect evaluation of calibrated endotracheal sputum suction depth on prevention of airway mucosal injury in elderly patients with mechanical ventilation

目的:探讨吸痰深度标定对ICU老年机械通气患者气道黏膜损伤的预防效果。方法:采用便利抽样法,选取2018年4月至10月入住ICU的60例经口气管插管机械通气老年患者,随机分为观察组和对照组各30例,两组患者均采用开放式吸痰方式,观察组标定吸痰管进入气道深度进行气道吸引,对照组采用吸痰管进入气道遇阻力回提1 cm的深度进行气道吸引。两组患者分别于气管插管当日和3日进行纤维支气管镜检查,观察隆突处黏膜损伤情况,并记录两组患者每日吸痰次数,在气管插管当日和3日对两组患者进行肺部感染评分(CPIS)。结果:两组患者每日吸痰次数差异无统计学意义(P>0.05),排除吸痰次数对隆突处黏膜损伤的影响。两组患者气管插管当日纤维支气管镜检查气道黏膜均无损伤,气管插管3日后,再次行纤维支气管镜检查发现,观察组隆突处黏膜损伤发生率低于对照组,差异有统计学意义(P<0.05)。两组患者在气管插管当日和3日CPIS结果差异无统计学意义(P>0.05)。结论:标定吸痰的深度,可以有效预防老年机械通气患者吸痰引起的气道黏膜损伤,达到有效吸痰的目的。

Objective:To investigate the effect of calibrated endotracheal sputum suction depth on preventing airway mucosal injury in elderly patients with mechanical ventilation.Methods:60 elderly patients admitted to ICU from April to October 2018 were selected as the research objects by convenience sampling method.They were randomly divided into the experimental group and the control group,with 30 cases in each group.The open endotracheal suctioning was used in both groups.The experimental group calibrated the depth of sputum aspiration tube into the airway,while the control group used the depth of sputum aspiration tube into the airway to draw back 1 cm when encountering resistance.Fiberoptic bronchoscopy was performed on the 0 and 3 days of endotracheal intubation respectively in the two groups to observe the mucosal injury at the carina,sputum aspiration times of patients in the two groups were recorded.Clinical pulmonary infection score(CPIS)were performed on days 0 and 3 of endotracheal intubation in the two groups.Results:No significant airway mucosal injury was observed on the first day of endotracheal intubation in either group.After 3 days of mechanical ventilation,fiberoptic bronchoscopy showed mucosal injury rates of carinain experimental group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the CPIS between the two groups on day 0 and day 3 of endotracheal intubation(P>0.05).Conclusion:For elderly patients in ICU,calibrating endotracheal depth can effectively achieve the purpose of sputum suction and prevent the airway mucosal injury caused by sputum aspiration.