气管切开患者气管内吸引负压的探讨

目的探讨不同负压对气管切开患者气管内吸引效果及对患者的影响,旨在探索最佳的吸引负压。方法通过对31例气管切开患者（共计187个观察日）,随机分为3个不同的吸引负压组,-20．0kPa组9例,-30．0kPa组12例,-40．0kPa组10例,分别采用-20．0kPa、-30．0kPa、-40．0kPa进行气管内吸引,研究不同压力水平下患者的24h吸痰总量、24h吸痰次数、气道黏膜损伤次数、平均吸引时间、吸痰彻底评分、心率改变均值、平均动脉压改变均值、SpO2改变均值。结果不同负压吸引的3组患者24h吸痰总量、24h吸痰次数、气道黏膜损伤次数、平均吸引时间、吸痰彻底评分、心率改变均值、平均动脉压改变均值及SpO2改变均值比较差异均有统计学意义（P〈0．05或P〈0．01）。-20．0kPa组24h吸痰总量、24h吸痰次数最多,平均吸引时间最长,吸痰彻底评分最低,-40．0KPa组气道黏膜损伤次数最多,对心率、平均动脉压、SpO2的影响最大,-30．0kPa组居中。结论气管切开患者气管内吸引采用-30．0kPa吸引时间相对较短、吸痰效果较好,气道黏膜损害小,对患者心率、平均动脉压、SpO2的影响较小,可相对减少吸痰次数,减少侵袭污染机会,临床可选择-30．0kPa作为气管切开患者气管内吸引的负压值。     

气管切开患者使用不同负压吸痰效果的研究

目的探讨气管切开患者最适宜的吸引负压。方法将31例气管切开患者随机分为低压组(负压为20～30kpa)15例和高压组(负压为30～40kpa)16例。观察不同负压吸引效果及对患者的影响,包括吸痰彻底评分、心率改变均值、平均动脉压(MBP)改变均值、SPO2改变均值、气道黏膜损伤次数。结果两组吸引对心率、MBP、SPO2的影响以及吸痰彻底评分比较无显著性差异(P>0.05)。高压组吸引对患者气道黏膜的损害大,有显著性差异(P<0.05)。结论临床工作中,为气管切开患者吸痰选用负压为20～30kpa压力吸引效果好,对患者的影响小。     

气管切开病人吸痰方法的改进

目的对45例气管切开病人的吸痰方法进行改进。方法将45例气管切开病人随机分为常规组（20例）,采用持续负压吸引的吸痰方法;试验组（25例）,吸痰过程中结合应用阻断或解除负压的方法。观察两种吸痰方法对气管黏膜损伤的影响。结果试验组吸痰方法明显优于常规组,有显著性差异（P〈0．01）。结论对气管切开病人在吸痰中结合应用阻断或解除负压的方法对气管黏膜的损伤较小。     

低负压间歇吸痰在头面颈烧伤合并吸入性损伤患者中的应用

目的:探讨低负压间歇吸痰法对头面颈烧伤合并吸人性损伤患者的影响.方法:选取2010年5月～2012年6月63例行气管切开的头面颈烧伤合并吸人性损伤的患者,将其按住院日期分为试验组31例(单号)和对照组32例(双号).对照组采用常规负压持续吸痰法;试验组采用低负压间歇吸痰法,即负压为6.7 ～22.6 kPa(50 ～ 170 mmHg),给予间断负压吸痰,每3s断开负压1次.比较两组患者的气管黏膜损伤情况、吸痰效果、平均吸痰量及平均吸痰次数.结果:试验组患者行低负压间歇吸痰后吸痰效果明显优于对照组,且在吸痰过程中气管黏膜损伤发生率低于对照组,差异有统计学意义(P＜0.05).试验组患者平均吸痰量和平均吸痰次数低于对照组,差异有统计学意义(P＜0.05).结论:低负压间歇吸痰法有助于促进细小支气管中痰液的排出,降低吸痰次数,减轻患者痛苦,促进机体康复.     

持续负压吸痰在气管切开呛咳有力病人中的应用效果观察

[目的]探讨持续负压吸痰在气管切开呛咳有力病人中的应用效果。[方法]选择气管切开呛咳有力未用呼吸机的病人60例,随机分为对照组和实验组,实验组应用持续负压吸痰法进行吸痰,对照组按照吸痰指证吸痰。观察两组24h护士更换气管垫次数、吸痰操作时间以及护理费用。[结果]持续负压吸痰减少了护士工作量、吸痰操作时间、病人费用。[结论]持续负压吸痰在气管切开呛咳有力病人中的应用效果良好。     

改进气管切开患者吸痰方法的效果观察

目的 探讨改进气管切开患者吸痰方法的可行性和效果.方法 将136例重度颅脑损伤气管切开浅昏迷患者采取随机数字表法分为观察组和对照组各68例,观察组采用改进后的方法吸痰,分浅部吸痰和深部吸痰,对照组实施传统吸痰方法.观察比较两组吸痰次数、吸痰时间和黏膜损伤情况.结果 观察组应用改进的吸痰方法,与对照组比较,每日吸痰次数和气道黏膜损伤发生较少,痰液吸净时间较短,差异均有统计学意义.结论 气管切开患者改进吸痰方法,可节省吸痰时间,减少吸痰次数,提高工作效率;减少患者黏膜损伤,提高护理质量.     

不同吸引负压对机械通气患者密闭式吸痰效果的对比

目的比较密闭式吸痰时负压10~20kPa与20~40kPa对机械通气患者吸痰效果的影响。方法2005年9月-2007年3月,选择老年气管切开机械通气患者21例,随机分为2组:低压组(n=10,吸引压力=10~20kPa)和高压组(n=11,吸引压力=20~40kPa),分别采用不同吸引负压密闭式吸痰各7d,比较2组患者吸痰前后动脉血氧饱和度(SPO2)、24h痰量、24h吸痰次数,吸痰间隔时间、气道黏膜损伤情况等。结果和低压组患者比较,高压组患者24h吸痰量少、24h吸痰次数少、吸痰间隔时间长(P<0.05),而吸痰前后2组患者的SPO2、气道黏膜情况无显著性差异(P>0.05)。结论机械通气患者采用高压(20~40kPa)密闭式吸痰的效果好,间隔时间长,可减轻患者的痛苦,提高工作效率。     

不同吸引负压对机械通气患者密闭式吸痰效果的对比

目的 比较密闭式吸痰时负压10～20 kPa与20～40 kPa对机械通气患者吸痰效果的影响.方法 2005年9月-2007年3月,选择老年气管切开机械通气患者21例,随机分为2组:低压组(n=10,吸引压力=10～20 kPa)和高压组(n=11,吸引压力=20～40 kPa),分别采用不同吸引负压密闭式吸痰各7 d,比较2组患者吸痰前后动脉血氧饱和度(SPO2)、24 h痰量、24 h吸痰次数,吸痰间隔时间、气道黏膜损伤情况等.结果 和低压组患者比较,高压组患者24 h吸痰量少、24 h吸痰次数少、吸痰间隔时间长(P＜0.05),而吸痰前后2组患者的SPO2、气道黏膜情况无显著性差异(P＞0.05).结论 机械通气患者采用高压(20～40 kPa)密闭式吸痰的效果好,间隔时间长,可减轻患者的痛苦,提高工作效率.     

吸痰深度标定对预防老年机械通气患者气道黏膜损伤的效果评价

目的：探讨吸痰深度标定对ICU老年机械通气患者气道黏膜损伤的预防效果。方法：采用便利抽样法,选取2018年4月至10月入住 ICU的60例经口气管插管机械通气老年患者,随机分为观察组和对照组各30例,两组患者均采用开放式吸痰方式,观察组标定吸痰管进入气道深度进行气道吸引,对照组采用吸痰管进入气道遇阻力回提1 cm的深度进行气道吸引。两组患者分别于气管插管当日和3日进行纤维支气管镜检查,观察隆突处黏膜损伤情况,并记录两组患者每日吸痰次数,在气管插管当日和3日对两组患者进行肺部感染评分（CPIS）。结果：两组患者每日吸痰次数差异无统计学意义（P>0.05）,排除吸痰次数对隆突处黏膜损伤的影响。两组患者气管插管当日纤维支气管镜检查气道黏膜均无损伤,气管插管3日后,再次行纤维支气管镜检查发现,观察组隆突处黏膜损伤发生率低于对照组,差异有统计学意义（P<0.05）。两组患者在气管插管当日和3日CPIS结果差异无统计学意义（P>0.05）。结论：标定吸痰的深度,可以有效预防老年机械通气患者吸痰引起的气道黏膜损伤,达到有效吸痰的目的。     

改进喉癌术后气切患者吸痰方法的效果观察

目的探讨改进喉癌术后气切患者吸痰方法的可行性和效果。方法选择喉癌手术治疗并同时行气管切开术的患者40例,随机分为对照组和观察组各20例。对照组实施常规喉癌术后气道护理;观察组按全程负压浅部吸痰联合氧气雾化吸入的个性化吸痰法进行气道护理。分析比较两组患者术后24~72 h吸痰次数、吸痰彻底程度、气道黏膜损伤情况、痰痂形成及吸痰舒适度等情况。结果观察组的术后24~72 h吸痰次数、吸痰彻底程度、气道黏膜损伤情况、痰痂形成、吸痰舒适度5项指标均优于对照组,差异均有统计学意义(P0.05)。结论全程负压浅部吸痰联合氧气雾化吸入法用于喉癌患者气管切开术后可减少吸痰次数,提高每次吸痰彻底程度,降低气道黏膜损伤率和痰痂形成率,同时提高吸痰舒适度,提高吸痰依从性,方法简单,适合推广。     

脑外伤患者气管切开后不同黏稠度痰液适宜吸痰负压的临床研究

目的 研究颅脑外伤患者气管切开后不同黏稠度痰液的适宜吸引负压.方法 以颅脑外伤后器官切开患者为研究对象,共43例.按照适时吸痰指征,根据患者痰液黏稠度选择不同吸引负压.Ⅰ度痰液:负压为13.3kPa、16.0kPa、20.0kPa和24.0kPa.Ⅱ度痰液:负压为20.0kPa、24.0kPa、26.7kPa和29.3kPa.Ⅲ度痰液:负压为26.7kPa、29.3kPa、33.3kPa和37.2kPa.测量每例患者吸痰前、吸痰后Imin、3min、5min血氧饱和度(SpO2),并记录每次吸痰时间和黏膜损伤情况.结果 Ⅰ度痰液在13.3-16.0kPa负压下吸痰,此时患者的SpO2下降幅度小,而且痰液吸净时间控制在25s左右;Ⅱ度痰液在24.0-26.7kPa负压下吸痰.此时患者的SpO2下降幅度小,而且痰液吸净时间控制在24-29s;Ⅲ度痰液在33.3kPa负压下吸痰,此时既可控制SpO2无显著下降,又保证痰液吸净时间在30s左右.结论 根据痰液黏稠度选择不同负压吸痰,推荐Ⅰ度、Ⅱ度和Ⅲ度痰液分别使用13.3-16.0kPa、24.0-26.7kPa和33.3kPa.临床护士应根据痰液黏稠度不同,选择适宜的吸痰负压,做到同时控制SpO2的下降幅度和吸痰时间,最大限度降低吸痰导致的低氧血症和气道黏膜损伤.     

Airway colonisation in long-term mechanically ventilated patients

Objective To evaluate the impact of continuous subglottic suctioning and semi-recumbent body position on bacterial colonisation of the lower respiratory tract.Design A randomised controlled trial.Setting The ten-bed medical ICU of a French university hospital.Patients Critically ill patients expected to require mechanical ventilation for more than 5 days.Interventions Patients were randomly assigned to receive either continuous suctioning of subglottic secretions and semi-recumbent body position or to receive standard care and supine position.Measurements and results Oropharyngeal and tracheal secretions were sampled daily and quantitatively cultured. All included patients were followed up from day 1 (intubation) to day 10, extubation or death. Ninety-seven samples of oropharynx and trachea were analysed (40 for the suctioning group and 57 for the control group). The median bacterial counts in trachea were 6.6 Log₁₀ CFU/ml (interquartile range, IQR, 4.4–8.3) in patients who received continuous suctioning and 5.1 Log₁₀ CFU/ml (IQR 3.6–5.5) in control patients. Most of the patients were colonised in the trachea after 1 day of mechanical ventilation (75% in the suctioning group, 80% in the control group). No significant difference was found in the daily bacterial counts in the oropharynx and in the trachea between the two groups of patients.Conclusion Tracheal colonisation in long-term mechanically ventilated ICU patients was not modified by the use of continuous subglottic suctioning and semi-recumbent body position.     

不同吸痰负压对重型颅脑损伤气管切开术后病人的效果研究

目的:探讨不同吸引负压对重型颅脑损伤病人气管切开术后的影响。方法:选择神经外科监护病房65例重型颅脑损伤并行气管切开术后病人为研究对象,随机分为A、B、C三组,分别采取90～120 mmHg、121～150 mmHg、151～180 mmHg压力进行气管内吸痰,分析3组病人吸痰前后ICP数值变化、吸痰频率、吸痰间隔、吸痰彻底评分以及7 d内气道黏膜损伤的发生率。结果:A组ICP的影响最小,达到的峰值最低,恢复至基线的时间最短,24 h吸痰频率最高,吸痰间隔最短,但吸痰效果最不理想。B组在吸痰后ICP升高,但平均ICP峰值较A组升高,并在2min左右恢复基线,24 h吸痰频率较低,吸痰间隔较长,吸痰效果较理想。C组对ICP的影响最大,达到的峰值最高,恢复至基线的时间最长,24 h吸痰频率最低,吸痰间隔最长,但吸痰效果最理想。3组吸痰负压7 d内气道黏膜损伤的发生率的比较有统计学意义(P<0.05)。结论:重型颅脑损伤病人气管切开术后宜采用121～150 mmHg负压进行气管内吸痰,较为安全有效。     

Validation of risk factors for the nursing diagnosis decreased intracranial adaptive capacity

Mitchell has proposed a series of factors that may aid in the identification of individual patients with intracranial hypertension at risk for decreased intracranial adaptive capacity. The etiology of decreased intracranial adaptive capacity is failure of normal intracranial compensatory mechanisms. The defining characteristic of this nursing diagnosis is repeated disproportionate increase in intracranial pressure (ICP) that can occur in response to a variety of noxious and nonnoxious stimuli. The purpose of this study was to determine predictive validity of two risk factors (wide amplitude of ICP tracing and increased level of ICP at rest) for the phenomenon of decreased intracranial adaptive capacity. Data were derived from secondary analysis of 30 recordings from a sample of eight children who had ICP monitoring as part of their medical treatment. Results indicated that wide amplitude of ICP tracing or wide amplitude plus increased level of ICP at rest (specificity and positive predictive value were each 100%) with suctioning and turning was more likely to be associated with a disproportionate increase in ICP than when an increased level of ICP at rest alone was the only risk factor (specificity = 25% and positive predictive value = 67% with suctioning and specificity and positive predictive value each = 40% with turning). It was also concluded that, despite high positive predictive values, the combination of risk factors was sufficient but not solely necessary for a disproportionate increase in ICP (false negative predictive value for wide amplitude was 65% with suctioning and false negative predictive value for increased level of ICP was 83% with suctioning and 43% with turning).(ABSTRACT TRUNCATED AT 250 WORDS)     

Requirement for 100% oxygen before and after closed suction

AIM: This paper reports an experimental study to determine whether giving 100% oxygen for 1 minute before and after closed suctioning is required. BACKGROUND: Some studies suggest that patients receiving closed suction do not require preoxygenation to minimize desaturation. METHODS: The study was conducted in 2002, with 30 patients receiving mechanical ventilation who had various positive end-expiratory levels. Two suctioning methods were used for each patient: one involving administration of 100% oxygen for 1 minute before and after suctioning and the other without hyperoxygenation. Samples of arterial blood gases were taken before and after suctioning. Heart rate, arterial oxygen saturation and mean arterial pressure measures were documented before, immediately after, 30 and 60 seconds after suctioning. RESULTS: Levels of partial oxygen pressure, arterial oxygen saturation and mean arterial pressure were significantly higher in patients who received 100% oxygen for 1 minute before and after suction, whereas partial carbon dioxide pressure and heart rate were similar in the two groups. CONCLUSIONS: In patients who did not receive 100% oxygen before and after closed suctioning, no significant falls in partial oxygen pressure and oxygen saturation were seen. A small number of patients were hypoxaemic before suctioning, and not [corrected] giving 100% oxygen might be deleterious for this category.     

智能监测和控制微创经皮肾镜取石术中肾盂内压的意义*

目的介绍一种监测和控制微创经皮肾镜取石术(MPCNL)中肾盂内压(RPP)的方法,并探讨其准确性和可靠性。方法 63例肾结石患者,男41例,女22例;平均年龄(41.6±15.6)岁,结石直径(3.7±1.1)cm。63例均在腰硬联合麻醉下行MPCNL,术中逆行置入F5输尿管导管连接有创监护仪测定肾盂出口压力。应用腔内灌注吸引压力监控平台(以下简称:平台)和可测量压力的经皮肾吸引鞘(以下简称:鞘)监控肾内压,鞘后端通过负压吸引装置及压力监测反馈装置连接至平台,平台设定肾盂内压控制值为-5 mmHg、肾盂内压警戒值为20 mmHg、肾盂内压极限值为30 mmHg。单纯灌注吸引期和灌注吸引碎石期分别给予300、400和500 ml/min流量持续灌注5 min,记录两时期肾盂出口压力和鞘所测压力。结果 63例患者均手术成功并未出现严重并发症。单纯灌注吸引期和灌注吸引碎石期在300、400和500 ml/min组的肾盂出口压力、测压吸引鞘压力与RPP控制值-5 mmHg差异均无统计学意义(P0.05)。结论联合具有压力反馈控制功能的灌注吸引平台和可测量压力的经皮肾吸引鞘能准确、实时地监测和控制RPP。     

气管切开病人两种湿化方法的效果比较

目的探讨气管切开病人气道的最佳湿化方式。方法50例气管切开病人随机分为两组,对照组25例,用输液泵将湿化液24h持续泵入气管内实施气道湿化;实验组25例,用输液泵将湿化液泵入经过改良的氧气驱动雾化器,以持续氧气驱动雾化吸入的方法湿化气道。比较两组在湿化效果、并发症、每日吸痰次数、气管切开置管时间的不同以及对血氧饱和度的影响。结果实验组在湿化效果方面优于对照组,并发症发生少（P〈0．05）;实验组每日吸痰次数少,气管切开置管时间缩短,与对照组比较,差异有统计学意义（P〈0．01）。两种湿化方式对血氧饱和度的影响差异无统计学意义（P〉0．05）。结论持续氧气驱动雾化吸入对于气管切开病人气道湿化效果优于持续湿化液泵入。     

Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial

STUDY OBJECTIVE: Endotracheal suctioning in intubated patients is routinely applied in most ICUs but may have negative side effects. We hypothesised that on-demand minimally invasive suctioning would have fewer side effects than routine deep endotracheal suctioning, and would be comparable in duration of intubation, length of stay in the ICU, and ICU mortality. DESIGN: Randomised prospective clinical trial. SETTING: In two ICUs at University Hospital Groningen, the Netherlands. PATIENTS: Three hundred and eighty-three patients requiring endotracheal intubation for more than 24 h. INTERVENTIONS: Routine endotracheal suctioning (n=197) using a 49-cm suction catheter was compared with on-demand minimally invasive airway suctioning (n=186) using a suction catheter only 29 cm long. MEASUREMENTS AND RESULTS: No differences were found between the routine endotracheal suctioning group and the minimally invasive airway suctioning group in duration of intubation [median (range) 4 (1-75) versus 5 (1-101) days], ICU-stay [median (range) 8 (1-133) versus 7 (1-221) days], ICU mortality (15% versus 17%), and incidence of pulmonary infections (14% versus 13%). Suction-related adverse events occurred more frequently with RES interventions than with MIAS interventions; decreased saturation: 2.7% versus 2.0% (P=0.010); increased systolic blood pressure 24.5% versus 16.8% (P<0.001); increased pulse pressure rate 1.4% versus 0.9% (P=0.007); blood in mucus 3.3% versus 0.9% (P<0.001). CONCLUSIONS: This study demonstrated that minimally invasive airway suctioning in intubated ICU-patients had fewer side effects than routine deep endotracheal suctioning, without being inferior in terms of duration on intubation, length of stay, and mortality.     

利多卡因在神志清醒患者吸痰中的应用

目的观察利多卡因在清醒患者吸痰中的应用。方法选取本院2009年6月至2010年6月需吸痰的清醒患者83例,随机分为观察组42例,对照组41例。观察组患者在吸引前沿气管内缓慢注入2％的利多卡因0．5—1ml,2—3min后行气道内吸引;对照组采用常规方法进行气道内吸引。结果两组患者咳嗽、疼痛、躁动、气管痉挛、低氧血症、心律异常、恶心等发生情况比较,差异有统计学意义（P〈0．01）;吸痰后出血发生情况比较,差异无统计学意义（P〉0．05）;两组患者吸痰过程中、吸痰后2min、吸痰后5min的血氧饱和度检测情况比较,差异有统计学意义（P〈0．01）。结论利多卡因能够减轻清醒患者吸痰中的机体反应,降低气管的敏感性,减轻患者痛苦,值得临床推广使用。     

Practices and predictors of analgesic interventions for adults undergoing painful procedures.

BACKGROUND: Research is limited on analgesic practices associated with the commonly performed procedures of turning, inserting central venous catheters, removing wound drains, changing dressings on nonburn wounds, suctioning the trachea, and removing femoral sheaths. OBJECTIVES: To determine types of analgesics administered for procedures, the prevalence and amounts of drugs given, and factors predictive of analgesic administration. METHODS: Pain was assessed before and immediately after procedures. Analgesic, sedative, and anesthetic agents administered within 1 hour before and/or during each procedure were noted RESULTS: A total of 5957 adult patients at 164 national and 5 international sites participated. Pain intensity increased at the time of procedure for all procedures. More than 63% of patients received no analgesics. Less than 20% received opiates; mean total dose of opiate was 6.44 mg (SD, 8.96 mg). Only 10% of patients received combination therapy. Factors associated with the likelihood of receiving opiates were pain intensity before a procedure, femoral sheath removal, being white, and the duration of a procedure. Patients less likely to receive opiates had a medical diagnosis or were having tracheal suctioning. Only 14.5% of the variance in the amount of opiate administered was explained by factors entered into multiple regression models. Type of procedure was the only significant predictor of amount of opiate administered. CONCLUSIONS: Most patients were not intentionally medicated even though pain intensity increased during their procedure. When used, analgesic amounts were low, and combination therapy was infrequent. Clinical trials are needed to evaluate optimal pain management for patients undergoing procedures.