CAJ | 학술논문

目的探讨大面积烧伤合并吸入性损伤患者气管切开术后的更佳吸痰护理模式.方法选取烧伤面积≥30％,年龄18 ～60岁,合并中、重度吸入性损伤,行气管切开术的患者作为研究对象,选取2009年1月至2010年10月收治患者作为传统吸痰组,2010年11月至2012年9月收治患者作为改进吸痰组.传统吸痰组按照医疗护理技术操作常规实施吸痰,将一次性吸痰管插入气道一定深度,打开负压,吸痰管自下慢慢上提,并左右旋转,以吸尽痰液;吸痰时机为按需和适时吸痰.改进吸痰组为有计划分次分段吸痰,第1次吸尽气管套管内的痰液,根据气管套管的规格号数计算吸痰管插入长度;第2次为更换吸痰管后,打开负压,插入吸痰管至气管隆突上1～2 cm,边捻搓吸痰管边上提;吸痰时机为行雾化吸入后,叩背或震动排痰毕进行,6～8次/d.结果改进吸痰组肺部感染率为30.43％,传统吸痰组为82.35％,两组比较差异有统计学意义(x2=15.604,P＜0.01).结论雾化吸入、叩背后有计划定时分段分次进行边捻搓边退吸痰管的吸痰护理方式优于按需适时传统吸痰护理,可以有助降低大面积烧伤合并吸入性损伤患者气管切开术后的肺部感染率.
목적 탐토대면적소상합병흡입성손상환자기관절개술후적경가흡담호리모식.방법 선취소상면적≥30％,년령18 ～60세,합병중、중도흡입성손상,행기관절개술적환자작위연구대상,선취2009년1월지2010년10월수치환자작위전통흡담조,2010년11월지2012년9월수치환자작위개진흡담조.전통흡담조안조의료호리기술조작상규실시흡담,장일차성흡담관삽입기도일정심도,타개부압,흡담관자하만만상제,병좌우선전,이흡진담액;흡담시궤위안수화괄시흡담.개진흡담조위유계화분차분단흡담,제1차흡진기관투관내적담액,근거기관투관적규격호수계산흡담관삽입장도;제2차위경환흡담관후,타개부압,삽입흡담관지기관륭돌상1～2 cm,변념차흡담관변상제;흡담시궤위행무화흡입후,고배혹진동배담필진행,6～8차/d.결과 개진흡담조폐부감염솔위30.43％,전통흡담조위82.35％,량조비교차이유통계학의의(x2=15.604,P＜0.01).결론 무화흡입、고배후유계화정시분단분차진행변념차변퇴흡담관적흡담호리방식우우안수괄시전통흡담호리,가이유조강저대면적소상합병흡입성손상환자기관절개술후적폐부감염솔.
Objective To explore a better sputum suction nursing model on the large area burn patients with inhalation injury patients after tracheotomy.Methods Patients with bums area ≥30％ aged 18-60 years,moderate or severe inhalation injury and tracheotomy were included.The patients in the traditional sputum suction group were chosen from January 2009 to October 2010,and received the sputum suction nursing according to the medical nursing technical operation,specific process was as follows:the disposable sputum suction tube was inserted into the airway in certain depth,was slowly lifted from the bottom,and was rotated around in order to completely suck up sputum; and the sputum suction time was on-demand timely.The patients in the improved sputum suction group were chosen from November 2010 to September 2012,and received the planned sputum suction,and the sputum in the tracheal cannula were sucked up for the first times,the length of suction tube insertion was calculated according to the specification of tracheal cannula; the sputum suction tube was changed at the second time,and was inserted into 1-2 cm above tracheal carina; the sputum suction time was after inhalation,call-back or vibration row phlegm,6-8 times/d.Results The pulmonary infection rate in the improved sputum suction group was 30.43％,and 82.35％ in the traditional sputum suction group,and the difference was statistically significant (x2 =15.604,P ＜ 0.01).Conclusions The improved sputum suction nursing method which was planned,inhalation,call-back,etc,is better than the traditional sputum suction,and it is helpful to reduce the pulmonary infection rate in large area burn patients with inhalation injury after tracheotomy.