联合吸痰法在心外科术后肺部感染中的应用研究

Application of combined suction method in cardiac surgery department patients with postoperative pulmonary infection

目的研究密闭式吸痰法联合纤维支气管镜吸痰法在心外科术后肺部感染中的效果。方法选取2016年9月-2017年8月心脏外科手术患者128例,随机分为观察组和对照组(各64例)。观察组采用密闭式吸痰法联合纤维支气管镜吸痰法、对照组采用密闭式吸痰法,观察两组患者术后肺部感染率、感染控制效果和吸痰量、吸痰次数及临床表现消失时间、抗菌药物使用时间、住院时间及心肺功能参数。结果对照组术后肺部感染14例、感染率21.88%,高于观察组术后肺部感染率6.25%(P<0.05)。观察组术后肺部感染临床控制率48.44%、总有效率93.75%均高于对照组(P<0.05)。观察组每日吸痰次数少于对照组,每次吸出痰液量多于对照组(P<0.05)。吸痰后,观察组PaO2、PaO2/FiO2及其差值高于对照组(P<0.05)。观察组体温恢复、咳嗽咳痰消失、肺部啰音消失、胸片显示炎症消失时间、抗菌药物使用时间、住院时间均少于对照组(P<0.05)。结论密闭式吸痰法联合纤维支气管镜吸痰法能及时、有效促进心脏外科术后患者气道痰液彻底排出,保证气道通畅,有助于降低术后肺部感染率和抗菌药物使用率,更好地促进了心外科患者术后机体功能恢复。

OBJECTIVE To explore the effect of closed suction method combined with fiberoptic bronchoscopy suction on prevention of postoperative pulmonary infection in patients of cardiac surgery department.METHODS A total of 128 patients who received cardiac surgery from Sep 2016 to Aug 2017 were enrolled in the study and randomly divided into the observation group and the control group,with 64 cases in each group.The observation group was treated with closed suction method combined with fiberoptic bronchoscopy suction,while the control group was treated with closed suction method.The incidence of postoperative pulmonary infection,effect of infection control,sputum suction amount,number of times of suction,time of disappearance of clinical manifestations,time of use of antibiotics,length of hospital stay and cardio-pulmonary function parameters were observed and compared between the two groups of patients.RESULTS The incidence rate of postoperative pulmonary infection of the control group was 21.88%(14 cases),higher than 6.25%of the observation group(P<0.05).The rate of clinical control of postoperative pulmonary infection and total effective rate of the observation group were respectively 48.44%and 93.75%,significantly higher than those of the control group(P<0.05).The number of times of daily suction of the observation group was significantly less than that of the control group,while the sputum suction amount of the observation group was significantly more than that of the control group(P<0.05).The PaO2 level,PaO2/FiO2 and the difference value were significantly higher in the observation group than in the control group after the suction(P<0.05).The time of recovery of body temperature,time of disappearance of pulmonary rales,time of disappearance of inflammation displayed in chest image,time of use of antibiotics and length of hospital stay were significantly shorter in the observation group than in the control group(P<0.05).CONCLUSION The closed suction method combined with fiberoptic bronchoscopy suction may effectively facilitate the completed discharge of airway sputum of cardiac surgery department patients,keep the airway clear,reduce the incidence of postoperative pulmonary infection and utilization rate of antibiotics,and promote the postoperative functional recovery.