【作者】 张楠；

【导师】 孙玫；

【作者基本信息】 天津医科大学 ， 护理学， 2015， 硕士

【摘要】 目的从吸痰安全性、有效性以及经济性三方面进行开放式与密闭式吸痰临床操作的比较,进而为临床吸痰方式的选取提供切实可靠的依据,在保证患者生命体征安全的情况下,进一步提升吸痰效力,促进肺感染患者的有效排痰,利于疾病的转归,同时减少吸痰操作的费用,提升护患满意度。方法将天津医科大学总医院重症医学科在2014年7月至2015年2月收治的130例经口气管插管接呼吸机辅助通气的肺感染住院患者随机分为开放吸痰组和密闭吸痰组。开放吸痰组(n=62,采用普通吸痰管进行开放式吸痰;密闭吸痰组(n=68,采用密闭式吸痰管进行气道分泌物的吸引)。收集吸痰操作前后患者的心率、平均动脉压、血氧饱和度的变化,记录吸痰操作吸出痰液量,并在吸痰操作后即刻进行的气管镜检查时收集、记录大气道的痰液量、黏膜情况。最终从吸痰安全性、有效性、经济性三方面衡量密闭式吸痰的临床应用效果,以指导临床吸痰操作时吸痰方式的选择。结果密闭式吸痰组和开放式吸痰组两组间比较吸痰操作前后的心率、平均动脉压、血氧饱和度6组数据,差异无统计学意义(p>0.05)。但是在开放式吸痰组中有20例因为心律、平均动脉压、血氧饱和度变化而提前终止吸痰,密闭吸痰组中7例提前终止吸痰。统计出密闭吸痰组吸痰前后心率、平均动脉压、血氧饱和度,差异无统计学意义(p>0.05),而开放组吸痰后心率、平均动脉压、血氧饱和度的比吸痰前有所升高,差异有统计学意义(p<0.05)。密闭式吸痰组单次吸出痰液量少于开放吸痰组,差异有统计学意义(p<0.05),气管镜检查发现,密闭式吸痰后大气道痰液剩余量明显多于开放式吸痰组,差异有统计学意义(p<0.05),两组患者吸痰操作与气管镜吸痰吸出的痰液总量,差异无统计学意义(p>0.05)。院内感染发生率差异无统计学意义(p>0.05),同时也观察到建立人工气道7日内应用密闭式吸痰其费用少于开放式吸痰组。结论密闭式吸痰对生命体征影响小,但在不考虑机械通气相关压力因素的影响情况下,对于Ⅱ度黏稠度的气道分泌物来说,吸痰效力是低的,应用48小时更换的密闭式吸痰管并不增加吸痰总费用,肺感染早期应用密闭式吸痰,恢复期更换为开放式吸痰为更经济的选择方法。肺感染患者院内感染的发生率与吸痰方式的选择无相关性。在临床选择上应综合考虑密闭式吸痰和开放式吸痰的吸痰效力和材料消耗的费用,综合选择最佳的吸痰方式。更多还原

【Abstract】 ObjectiveClosed endotracheal suctioning(CES) and open endotracheal suctioning(OES) were compared inthree aspects as their safety, effectiveness and economical efficiency. The change of heart rates(HR), mean arterial pressure(MAP) and oxygen saturation(SPO2) were investigated to evaluate the safety of both suction practices. Suctioning effectiveness was assessed by its efficacy and frequency, while economical efficacy was determined by material costs and nurse’s workload.This study aimed to provide reliable evidence for choosing the suctioning methods on the premise of assuring the safety of the patients’ body signs, in order to further improve the efficacy of suctioning, reduce the medical costs, enhance patient satisfaction, and promote high quality nursing. Methods130 patients of tracheal intubation via oral cavity, who were cured in the intensive care unit, Tianjin medical university general hospital between July 2014 and February 2015, were randomly assigned to OES Group and CES Group. OES Group(n=62, sum to 127 bronchoscope sputum suctions) were suctioned in OES method by normal suction tubes. CES Group(n=68, sum to 111 bronchoscope sputum suctions) were suctioned in CES method by closed endotracheal suction tubes. We collected the change in HR, MAP, SPO2 from pre-suction baseline, meanwhile recorded sputum volume of this suctioning and the sputum volume in large airway and mucosa condition by bronchoscope sputum suction which was conductedfollowing the suctioning. Thus, the clinical application of ECS could be evaluated in ways of its safety,effectiveness and the economical efficacy, which mayprovide reliable evidence for the choice of different suctioning methods. ResultsCES Group have no obvious change in HR, MAP, SPO2 after suctioning(p>0.05). CES Group also have no obvious change in body signs(p>0.05). But there are 20 items ended sputum head of time for the change of body signs in OES Group, only 7 items in CES Group. CES Group can suction less sputum volume than OES Group(p<0.05). CES Group’s remaining sputum volume in large airway by bronchoscope were obvious more than OES Group’s(p<0.05).Total sputum volume of the two groups have no difference(p>0.05). The all-in cost of suctioning was obvious reduced by CES method in the 7 days after establishing artificial airway. ConclusionCES conducts low influence to body signs, but effectiveness of suctioning is low in sputumviscosity of two degree, if we do not consider the correlation factors ofmechanical ventilation. CES will not increase the cost in suctioning. It is a more economical method if we use CES method in early stage of infection, and change to OES method in restoration stage. This research cannot make sure the relationship of the rate of secondary pulmonary infection and the choice of suctioning methods. In clinical, people should synthesize the material costs and suctioning effectiveness of CES and OES, and choose the best suctioning method overall.更多还原