CAJ | 학술논문

目的：了解神经外科ICU患者胃内容物反流及误吸的发生率，分析发生误吸的高危因素，为临床及时给予有效护理干预措施，预防误吸发生，减轻误吸并发症提供依据。方法选取某三级甲等医院神经外科ICU机械通气患者进行病情观察，收集年龄、性别、体位、意识状态、胃潴留量、鼻饲管口径、人工气道气囊压力等数据，采集咽喉部分泌物及气管分泌物，进行胃蛋白酶检测。结果观察235例次患者，胃内容物反流的发生率为48.1%，误吸发生率为38.3%。经单因素分析得出不同胃管直径型号、气管插管/气管切型号、鼻饲液泵入速度、胃潴留量、Glasgow评分、气囊压力及是否使用镇静剂患者误吸发生率差异有统计学意义（P<0.05或P<0.01）。进一步采用Logistic回归分析，患者误吸的影响因素为 Glasgow评分、鼻饲液泵入速度、胃潴留量和气囊压力。结论根据胃内容物反流误吸的发生原因，随时观察患者的病情变化，特别注意患者的意识状态和胃潴留量，检测气管插管或气管切开的气囊压力，采取合理的鼻饲液泵入速度，以降低胃内容物反流误吸率。
목적：료해신경외과ICU환자위내용물반류급오흡적발생솔，분석발생오흡적고위인소，위림상급시급여유효호리간예조시，예방오흡발생，감경오흡병발증제공의거。방법선취모삼급갑등의원신경외과ICU궤계통기환자진행병정관찰，수집년령、성별、체위、의식상태、위저류량、비사관구경、인공기도기낭압력등수거，채집인후부분비물급기관분비물，진행위단백매검측。결과관찰235례차환자，위내용물반류적발생솔위48.1%，오흡발생솔위38.3%。경단인소분석득출불동위관직경형호、기관삽관/기관절형호、비사액빙입속도、위저류량、Glasgow평분、기낭압력급시부사용진정제환자오흡발생솔차이유통계학의의（P<0.05혹P<0.01）。진일보채용Logistic회귀분석，환자오흡적영향인소위 Glasgow평분、비사액빙입속도、위저류량화기낭압력。결론근거위내용물반류오흡적발생원인，수시관찰환자적병정변화，특별주의환자적의식상태화위저류량，검측기관삽관혹기관절개적기낭압력，채취합리적비사액빙입속도，이강저위내용물반류오흡솔。
Objective To explore the incidence rate of reflux and aspiration of gastric contents of patients in neurosurgical ICU, to analyze the risk factors of aspiration and to provide a basis for aspiration prevention. Methods According to inclusion and exclusion criteria, totally 235 patients in neurosurgical ICU of one hospital in Beijing were included, then patients ’ general information and condition were recorded and throat secretions and tracheal secretions were collected for pepsin testing. Results The incidence rate of gastric contents reflux was 48.1%, and that of aspiration 38.3%. The chi-square test results showed that the diameter of nasogastric feeding tube, that of endotracheal intubation/tracheostomy tube, nasal feeding liquid input speed, the amount of gastric retention, Glasgow score, airbag pressure, and sedatives using were related to the occurrence of aspiration ( P<0.05 or P<0.01). Logistic regression analysis indicated that influencing factors affecting aspiration were Glasgow score, nasal feeding liquid input speed, gastric retention volume and airbag pressure. Conclusion To prevent reflux and aspiration of gastric contents,observe patient ’s condition change and patient’s state of consciousness and the amount of gastric retention , detect the airbag pressure of endotracheal intubation or tracheostomy tube, take reasonable speed feeding of nasal feeding.