经口气管插管患者口腔黏膜压力性损伤的危险因素分析

Risk factors analysis of oral mucous membrane pressure injury in oral endotracheal intubation patients

目的探讨经口气管插管患者口腔黏膜压力性损伤的发生情况及其危险因素。方法回顾性分析2022年7月—2023年3月浙江省立同德医院急诊重症监护室102例经口气管插管患者的一般资料、临床资料和气管导管使用资料,采用单因素分析和二元Logistic回归分析经口气管插管患者口腔黏膜压力性损伤的潜在危险因素。结果102例经口气管插管患者中,有33例(32.4%)患者发生口腔黏膜压力性损伤。单因素分析结果显示,7个因素差异具有统计学意义,其分别是急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ评分)(t=5.540,P<0.001)、低蛋白血症(χ^(2)=16.127,P<0.001)、贫血(χ^(2)=18.638,P<0.001)、使用血管活性药物(χ2=7.947,P=0.005)、使用抗凝药物(χ^(2)=9.167,P=0.002)、气管导管型号(χ^(2)=-3.193,P=0.001)和气管导管留置时间(Z=-5.476,P<0.001)。多因素二元Logistic回归分析结果显示,APACHEⅡ评分(OR=1.694,P=0.002,95%CI:1.211~2.368)、低蛋白血症(OR=6.618,P=0.034,95%CI:1.149~38.106)、气管导管型号(OR=7.489,P=0.017,95%CI:1.430~39.217)、气管导管留置时间(OR=1.103,P=0.001,95%CI:1.005~1.020)为经口气管插管患者口腔黏膜压力性损伤发生的独立危险因素。结论经口气管插管口腔黏膜压力性损伤发生率较高,APACHEⅡ评分、低蛋白血症、气管导管型号、气管导管留置时间为独立危险因素。建议在满足临床治疗要求的前提下尽量选择更小型号的气管导管,缩短气管导管的留置时间,加强营养支持,以预防经口气管插管患者口腔黏膜压力性损伤的发生。

Objective To determine the incidence and potential risk factors of tracheal catheter-related oral mucosal injury in patients with oral intubation.Methods The general data,clinical data and tracheal catheter usage data of 102 patients with oral intubation in the emergency intensive care unit of Tongde Hospital of Zhejiang Province from July 2022 to March 2023 were retrospectively analyzed.The potential risk factors of tracheal catheter-related oral mucosal injury in patients with oral intubation were analyzed by univariate and binary logistic regression.Results Among 102 cases,33 cases(32.4%)had tracheal catheter-related oral mucosal pressure injury.Univariate analysis showed statistically significant differences in APACHEⅡscore(t=5.540,P<0.001),hypoproteinemia(χ^(2)=16.127,P<0.001),anemia(χ^(2)=18.638,P<0.001),vasoactive drugs(χ^(2)=7.947,P=0.005),anticoagulants(χ^(2)=9.167,P=0.002),tracheal catheter type(χ^(2)=-3.193,P=0.001)and time of indwelling tracheal catheter(Z=-5.476,P<0.001).Multivariate binary logistic regression analysis showed that APACHEⅡscore(OR=1.694,P=0.002,95%CI:1.211-2.368),hypoproteinemia(OR=6.618,P=0.034,95%CI:1.149-38.106),tracheal catheter type(OR=7.489,P=0.017,95%CI:1.430-39.217)and tracheal time of indwelling tracheal catheter(OR=1.103,P=0.001,95%CI:1.005-1.020)were independent factors of tracheal catheter-related oral mucosa injury.Conclusions The incidence of oral mucosal pressure injury through oral tracheal intubation is relatively high,with APACHEⅡscore,hypoproteinemia,tracheal catheter type,and tracheal time of indwelling tracheal catheter as independent risk factors.It is recommended to choose smaller tracheal catheters as much as possible in clinical practice,while meeting treatment requirements,to shorten the tracheal time of indwelling tracheal catheter,strengthen nutritional support,and prevent the occurrence of oral mucosal pressure injury in patients undergoing oral tracheal intubation.