超早产儿无创机械通气管路固定方法的改良与应用效果

Modification and effects of non-invasive mechanical ventilation tube fixation in ultra-premature infants

目的对超早产儿无创机械通气(NIV)治疗中的通气管、鼻塞/罩(以下简称组件)固定方法进行改良,探讨其在超早产儿NIV治疗中的应用效果。方法根据超早产儿特点及临床需求,循证设计、制作一款新型固定帽,用于固定超早产儿NIV治疗中的组件。选取2019年1-6月解放军总医院第七医学中心超早产儿重症监护病房NIV治疗中的75例超早产儿作为研究组,选取2018年7-12月NIV治疗中的75例超早产儿作为对照组。研究组采用改良方法固定NIV治疗中的组件,对照组采用传统方法进行固定。比较两组患儿NIV相关组件在位情况以及通气压力达标情况,观察两组患儿鼻、面、额部损伤情况以及医护人员对改良固定方法的满意度。结果研究组超早产儿的NIV相关组件在位率、通气压力达标情况明显优于对照组,鼻、面、额部损伤发生率低于对照组,差异有统计学意义(P<0.05)。医护人员对固定方法的满意度由50.7%提升至81.3%(P<0.01)。结论改良固定方法能有效提高NIV治疗中相关组件在位率、通气压力达标情况,从而提高通气效果,可以有效降低超早产儿NIV治疗中的鼻、面、额部损伤。

Objective To modify the fixation method of ventilation tube,nasal rhinobyon/mask(hereinafter referred to as components)in non-invasive ventilation(NIV)for ultra-premature infants,and explore its effects in NIV for ultra-premature infants.Methods According to the characteristics and clinical needs of ultra-premature infants,a new type of fixation cap was designed and manufactured based on evidence to fix the components in NIV for ultra-premature infants.Totally 75 ultra-premature infants undergoing NIV in the Intensive Care Unit for Ultra-premature Infants in the Seventh Medical Center of Chinese PLA General Hospital from January to June 2019 were included into the study group,while 75 ultra-premature infants undergoing NIV from July to December 2018 were included into the control group.The NIV components were fixed with the modified method for patients in the study group,whereas the NIV components were fixed with the traditional method for patients in the control group.The occupancy rate of NIV-related components and the compliance of ventilation pressure were compared between the two groups.The nasal,facial,and forehead injuries of the two groups of children as well as the medical staff's satisfaction with the improved fixation method were observed.Results The occupancy rate of NIV-related components and the compliance of ventilation pressure in the study group was obviously better than those in the control group,and the incidence of nasal,facial,and forehead injuries was significantly lower than that in the control group,with statistically significant differences(P<0.05).The medical staff's satisfaction with the fixation method increased from 50.7%to 81.3%(P<0.01).Conclusions The modified fixation method can effectively improve the occupancy rate of NIV-related components and the compliance of ventilation pressure in NIV treatment,thereby improving the ventilation effect,and effectively reducing the nasal,facial,and forehead injuries during NIV treatment in ultra-premature infants.