CAJ | 학술논문

目的观察声门下分泌物持续稳压吸引结合间断加压吸引在建立人工气道患者中应用的效果.方法于2013年1-11月将入住ICU的44例气管切开患者采用随机数字表法分为观察组和对照组,每组22例.对照组患者行声门下分泌物持续稳压吸引,观察组患者在持续稳压吸引的基础上增加间断加压吸引.比较两组每日吸引量、呼吸机相关性肺炎(VAP)发生率、每日呛咳次数、气道黏膜损伤、引流管发生堵塞等情况.结果两组各有2例患者因自动出院未完成观察研究.观察组声门下分泌物吸引量为(52.80 ±4.181) ml,多于对照组的(33.00±2.675) ml,差异有统计学意义(t=16.656,P＜0.05).观察组和对照组患者早期VAP的发生率分别为10.0％和40.0％,组间比较差异有统计学意义(x2 =4.800,P＜0.05).观察组患者每日呛咳次数为(1.93±1.023)次,气道黏膜损伤的发生率为15.0％,对照组分别为(1.75±1.006)次和10.0％,两组比较差异无统计学意义(t/x2值分别为0.771,0.229;P＞0.05).观察组发生引流管堵管率0.0％,对照组发生引流管堵管率20.0％,组间比较差异有统计学意义(x2 =4.444,P＜0.05).结论声门下分泌物持续稳压吸引结合间断加压吸引可增加吸引量,减少引流管的堵管发生率,有效降低早期VAP的发生,可以有效提高声门下吸引效果.
목적 관찰성문하분비물지속은압흡인결합간단가압흡인재건립인공기도환자중응용적효과.방법 우2013년1-11월장입주ICU적44례기관절개환자채용수궤수자표법분위관찰조화대조조,매조22례.대조조환자행성문하분비물지속은압흡인,관찰조환자재지속은압흡인적기출상증가간단가압흡인.비교량조매일흡인량、호흡궤상관성폐염(VAP)발생솔、매일창해차수、기도점막손상、인류관발생도새등정황.결과 량조각유2례환자인자동출원미완성관찰연구.관찰조성문하분비물흡인량위(52.80 ±4.181) ml,다우대조조적(33.00±2.675) ml,차이유통계학의의(t=16.656,P＜0.05).관찰조화대조조환자조기VAP적발생솔분별위10.0％화40.0％,조간비교차이유통계학의의(x2 =4.800,P＜0.05).관찰조환자매일창해차수위(1.93±1.023)차,기도점막손상적발생솔위15.0％,대조조분별위(1.75±1.006)차화10.0％,량조비교차이무통계학의의(t/x2치분별위0.771,0.229;P＞0.05).관찰조발생인류관도관솔0.0％,대조조발생인류관도관솔20.0％,조간비교차이유통계학의의(x2 =4.444,P＜0.05).결론 성문하분비물지속은압흡인결합간단가압흡인가증가흡인량,감소인류관적도관발생솔,유효강저조기VAP적발생,가이유효제고성문하흡인효과.
Objective To observe the effect of the continuous low pressure suctioning unite intermittent high pressure suctioning on drainage of subglottic secretions in the patients with artificial airway.Methods Using random number table,a total of 44 patients were evenly and randomly divided into observation group and control group.In the control group,continuous low pressure suctioning was performed to clear away the subglottic secretions.In the observation group,continuous low pressure suctioning combined with intermittent high pressure suctioning were performed.The average daily drainage volume of subglottic secretion,the incidence of early onset VAP (Ventilatorassociated pneumonia),the frequence of cough,the incidence of the airway mucosal damage,the incidence of the clogging of the drainage tube were investigated and compared between two groups.Results The average daily drainage volume of subglottic secretion in the observation group (52.80 ±4.181)ml was significantly more than in the control group (33.00 ± 2.675) ml (t =16.656,P ＜ 0.05).The incidence of early onset VAP in the observation group (10.0％) was significantly less than in the control group (40.0％) (x2 =4.800,P ＜ 0.05).There was no statistical difference in the frequence of cough between the observation group (1.93 ± 1.023) times and the control group (1.75 ± 1.006) times (t =0.771,P ＞ 0.05).There was no statistical difference in the incidence of the mucosal damage of airway between the observation group (15％) and the control group(10％) (x2 =0.229,P ＞0.05).The incidence of the clogging of the drainage tube in the observation group (0.0％) was significantly less than in the control group (20.0％) (x2 =4.444,P ＜0.05).Conclusions Continuous low pressure suctioning combined with intermittent high pressure suctioning can significantly improve the effect of drainage of the subglottic secretions by increasing the drainage volume,reducing the clogging of the drainage tube and the early onset of VAP.