CAJ | 학술논문

目的了解加强呼吸道管理措施对吸入性损伤气管切开患者肺部感染的防治效果.方法将笔者单位2000年1月--2004年12月收治的14例烧伤伴吸入性损伤患者设为对照组,予以常规全身治疗及常规呼吸道管理;2005年1月-2009年10月收治的27例烧伤伴吸入性损伤患者设为加强组,予以常规全身治疗并加强呼吸道管理,具体措施包括呼吸道"床边隔离"与双管(给氧管、湿化管)固定、体位"定向"湿化与痰液稀释、气道灌洗与程序式排痰、药物联合雾化治疗、"间断负压法"吸痰等.对比观察2组患者的痰液(气管切开后第7天)细菌培养结果、胸部X线片检查(入院后即刻和气管切开后第7天)结果、肺部感染情况、SO_2和血气分析指标(气管切开后7 d内)以及各组患者治愈率. 结果 (1)对照组患者中11例痰液细菌培养呈阳性占78.6%、加强组12例呈阳性占44.4%,组间比较,差异有统计学意义(X~2=4.36,P<0.05).均以铜绿假单胞菌为主要检出菌.(2)胸部X线片提示,加强组7例患者发生肺炎占25.9%,明显少于对照组(8例,占57.1%,X~2=3.87,P<0.05).肺部感染确诊结果与此一致.(3)2组患者观察期间均未出现CO_2潴留现象,无窒息引起的PaCO_2、SO_2异常,PaCO_2值组间接近(t=0.89,P>0.05).(4)对照组治愈9例占64.3%,死亡5例,分别死于肺炎、创面脓毒症、MODS.加强组治愈25例占92.6%,死亡2例,死亡原因均为MODS.加强组治愈率明显高于对照组(X~2=5.22,P<0.05). 结论加强呼吸道管理措施对气道起到较好的滤过及隔离、湿化作用,便于痰液稀释、引流与排出,减少了盲目吸痰的概率与操作性损伤.有利于防治气管切开后继发的肺部感染.
목적 료해가강호흡도관리조시대흡입성손상기관절개환자폐부감염적방치효과.방법 장필자단위2000년1월--2004년12월수치적14례소상반흡입성손상환자설위대조조,여이상규전신치료급상규호흡도관리;2005년1월-2009년10월수치적27례소상반흡입성손상환자설위가강조,여이상규전신치료병가강호흡도관리,구체조시포괄호흡도"상변격리"여쌍관(급양관、습화관)고정、체위"정향"습화여담액희석、기도관세여정서식배담、약물연합무화치료、"간단부압법"흡담등.대비관찰2조환자적담액(기관절개후제7천)세균배양결과、흉부X선편검사(입원후즉각화기관절개후제7천)결과、폐부감염정황、SO_2화혈기분석지표(기관절개후7 d내)이급각조환자치유솔. 결과 (1)대조조환자중11례담액세균배양정양성점78.6%、가강조12례정양성점44.4%,조간비교,차이유통계학의의(X~2=4.36,P<0.05).균이동록가단포균위주요검출균.(2)흉부X선편제시,가강조7례환자발생폐염점25.9%,명현소우대조조(8례,점57.1%,X~2=3.87,P<0.05).폐부감염학진결과여차일치.(3)2조환자관찰기간균미출현CO_2저류현상,무질식인기적PaCO_2、SO_2이상,PaCO_2치조간접근(t=0.89,P>0.05).(4)대조조치유9례점64.3%,사망5례,분별사우폐염、창면농독증、MODS.가강조치유25례점92.6%,사망2례,사망원인균위MODS.가강조치유솔명현고우대조조(X~2=5.22,P<0.05). 결론 가강호흡도관리조시대기도기도교호적려과급격리、습화작용,편우담액희석、인류여배출,감소료맹목흡담적개솔여조작성손상.유리우방치기관절개후계발적폐부감염.
Objective To observe the preventive and therapeutic effect of advanced airway manage-ment on pulmonary infection in patients with inhalation injury after tracheotomy. Methods Fourteen burn patients with inhalation injury admitted to our hospital from January 2001 to December 2004 were enrolled as control (C) group, and they were treated with conventional systemic therapy and management of airway.Twenty-seven burn patients with inhalation injury admitted to our hospital from January 2005 to October 2009 were enrolled as advanced (A) group, and they were treated with conventional systemic therapy and ad-vanced airway management, including bedside isolation of airway, fixation of both oxygen supply tube and humidifying tube, humidification in specific body position, thinning of sputum, lavement of airway and pro-cedural sputum elimination, steam inhalation combined with medicine, and suction of sputum with interrupt-ed negative pressure. Result of bacterial culture of sputum (the 7th day after tracheotomy) and chest X-ray (at admission and the 7th day after tracheotomy), pulmonary infection, change in blood gas analysis index and oxygen saturation (SO_2) (within 7 days after tracheotomy), and the number of patients cured in 2 groups were observed and compared. Results (1) Positive result of bacterial culture of sputum was ob-served in 11 (78.6%) patients in C group and 12 (44.4%) patients in A group. The difference between them was statistically significant (X~2=4.36, P<0.05). The main bacterium detected was Pseudomonas aeruginosa. (2) Pneumonia was suspected in 7 patients (25.9%) in A group by chest X-ray, which wasobviously fewer than that in C group (8 cases, 57.1% , X~2=3.87, P<0.05). The result was in accord-ance with the diagnosis of pulmonary infection. (3) No CO_2 retention, SO_2 and PaCO_2 abnormality caused by asphyxia was observed in 2 groups. PaCO_2 value in A group was close to that in C group (t=0.89, P>0.05). (4) In C group, 9 (64.3%) patients were cured, 5 patients died of pneumonia, wound sepsis,and MODS. In A group, 25 (92.6%) patients were cured, 2 patients died of MODS. Number of cure was obviously larger in A group than in C group (X~2=5.22, P <0.05). Conclusions The advanced airway management has better effects on isolation and humidification of airway, and thinning, drainage, and elimi-nation of sputum. And it can decrease the probability of blind suction and injury to airway, and it prevents pulmonary infection following tracheotomy.