在气管切开后肺部感染意识障碍患者中应用3/4俯卧位引流的效果观察

Application of three-fourths prone position drainage in patients with pulmonary infection and consciousness disorders after tracheotomy

目的分析3/4俯卧位引流法在气管切开后肺部感染意识障碍患者中的应用效果。方法选择2018年1月至2020年10月温州医科大学附属第一医院收治的气管切开后肺部感染的意识障碍患者84例,采用随机数字表法分为对照组和观察组,每组42例。对照组实施气管切开后肺部感染常规俯卧位引流法,观察组采取3/4俯卧位引流法。比较2组患者引流前后的PaO_(2)、PaCO_(2),引流后的引流效果、肺部感染灶吸收情况以及患者住院期间应用抗生素治疗肺部感染的时间。结果引流后,观察组PaO_(2)、PaCO_(2)分别为(91.87±7.21)、(35.34±3.28)mmHg(1 mmHg=0.133 kPa),对照组分别为(85.23±7.90)、(43.41±3.39)mmHg,差异有统计学意义(t=-4.02、11.09,均P<0.05)。引流后,观察组显效率、有效率、无效率分别为78.57%(33/42)、19.05%(8/42)、2.38%(1/42),对照组分别为33.33%(14/42)、45.24%(19/42)、21.43%(9/42),观察组引流效果明显优于对照组,差异有统计学意义(Z=-4.28,P<0.05)。引流后,观察组肺部感染灶完全吸收率、住院期间应用抗生素治疗肺部感染的时间分别为59.52%(25/42)、(10.67±2.70)d,对照组分别为35.71%(15/42)、(13.51±3.46)d,差异有统计学意义(χ2=4.77,t=4.19,均P<0.05)。结论3/4俯卧位引流法在气管切开后肺部感染意识障碍患者中的应用效果显著,可有效提高引流效果,改善氧合,促进肺部感染灶吸收,缩短抗生素治疗时间。

Objective To analyze the application effect of three-fourths prone position drainage method in patients with pulmonary infection and consciousness disorders after tracheotomy.Methods A total of 84 patients with consciousness disorders who were admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to October 2020 with pulmonary infection after tracheotomy were selected.They were divided into the control group and the observation group,there were 42 cases in each group according to random number table method.The control group received routine prone position drainage for pulmonary infection after tracheotomy and the observation group was given three-fourths prone position drainage method.The arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))before and after intervention,the drainage effect after the intervention,the absorption of pulmonary infection foci,and the time of antibiotic treatment for pulmonary infection during the patients′hospitalization were compared between the two groups.Results After the intervention,PaO_(2) and PaCO_(2) were(91.87±7.21),(35.34±3.28)mmHg(1 mmHg=0.133 kPa)in the observation group,and(85.23±7.90),(43.41±3.39)mmHg in the control group,the differences between the two groups were statistically significant(t=-4.02,11.09,both P<0.05).After the intervention,the apparent rate,effective rate,and ineffective rate were 78.57%(33/42),19.05%(8/42),2.38%(1/42)in the observation group,and 33.33%(14/42),45.24%(19/42),21.43%(9/42)in the control group.The drainage effect of the observation group was better than that of the control group,and the difference was statistically significant(Z=-4.28,P<0.05).After the intervention,the complete absorption rate of the pulmonary infection foci and the time taken to treat pulmonary infection with antibiotics during hospitalization were 59.52%(25/42),(10.67±2.70)d in the observation group,and 35.71%(15/42),(13.51±3.46)d in the control group,the differences were statistically significant(χ^(2)=4.77,t=4.19,both P<0.05).Conclusions The three-fourths prone position drainage method has significant application effect in patients with pulmonary infection and consciousness disorder after tracheotomy.It can effectively improve the drainage effect,improve oxygenation,promote the absorption of lung infections,and shorten the antibiotic treatment time.