口腔颌面部肿瘤切除同期游离组织瓣移植修复术后保留经鼻气管插管患者鼻压力性损伤的预防研究

Prevention of nasal pressure injury in patients with preserved nasal endotracheal intubation after oral and maxillofacial neoplasms resection and simultaneous free tissue flap transplantation

目的探讨口腔颌面部肿瘤切除同期游离组织瓣移植修复术后保留经鼻气管插管患者鼻压力性损伤的预防方法。方法采用便利抽样法,选取2018年8月—2019年12月在北京大学口腔医院行口腔颌面部肿瘤切除同期游离组织瓣移植修复手术的520例患者为研究对象,按照随机数字表法分为试验组和对照组。对照组采用常规护理;试验组使用丝绸布胶带偏离原压迫部位重新固定气管插管,异形充气气球支撑气管插管尾部。比较两组患者的鼻压力性损伤发生率、医用粘胶相关性皮肤损伤(MARSI)和气管插管固定问题导致的并发症发生情况。最终试验组246例患者、对照组248例患者完成研究。结果两组均未发生3期及以上的鼻压力性损伤。试验组患者经鼻气管插管相关的鼻压力性损伤发生率为2.85%(7/246),低于对照组的12.10%(30/248)(χ^(2)=15.254,P<0.001)。两组患者的MARSI发生情况比较,差异无统计学意义(P>0.05)。两组患者均未发生气管插管固定问题导致的并发症。结论采用丝绸布胶带重新固定气管插管,同时结合异形充气气球支撑气管插管尾部能够预防鼻压力性损伤,安全性较好。

Objective To explore the preventive measures of nasal pressure injury in patients with preserved nasal endotracheal intubation after oral and maxillofacial neoplasms resection and simultaneous free tissue flap transplantation.Methods Using the convenient sampling method,a total of 520 patients who underwent oral and maxillofacial neoplasms resection and simultaneous free tissue flap transplantation in Peking University Hospital of Stomatology were selected as the research objects from August 2018 to December 2019.According to the random number table method,they were divided into the experimental group and the control group.Patients in the control group received routine care,while in the experimental group,silk surgical tape was used to re-fix the endotracheal intubation tube away from the original position,and the special-shaped inflatable balloon was used to support the remote end of the tube.The incidence of nasal pressure injury,medical adhesive-related skin injury(MARSI)and the occurrence of complications caused by the fixation of tracheal intubation of patients were compared between the two groups.In the end,246 patients in the experimental group and 248 patients in the control group completed the study.Results No stage 3 or above nasal pressure injury occurred in the two groups.The incidence of nasal pressure injury related to nasotracheal tube in the experimental group was 2.85%(7/246),lower than 12.10%(30/248)in the control group(χ^(2)=15.254,P<0.001).There was no statistically significant difference in the incidence of MARSI of patients between the two groups(P>0.05).No complications caused by endotracheal intubation fixation occurred in both groups.Conclusions The use of silk surgical tape to re-fix the endotracheal intubation and the combination of special inflatable balloon to support the end of the endotracheal intubation can prevent nasal pressure injury,and the safety is better.