冲洗法用于经口气管插管患者口腔护理的效果评价

目的评价冲洗法用于经口气管插管患者口腔护理的效果，探讨经口气管插管患者合适的口腔护理方法。方法选取脑外科手术后需停留经口气管插管的患者150例，分为对照组73例与实验组77例，实验组采用冲洗法实施口腔护理，对照组实施传统的口腔护理方法。比较2组患者口腔异味、口腔湿润度及牙菌斑指数情况。结果实验组的口腔异味发生率、牙菌斑指数显著低于对照组；口腔湿润度显著高于对照组，2组比较差异有统计学意义，P〈0.01。结论口腔冲洗法能有效控制口腔异味，保持患者口腔湿润，有效抑制患者牙菌斑的形成。     

冲洗法用于经口气管插管患者口腔护理的效果评价

目的 评价冲洗法用于经口气管插管患者口腔护理的效果,探讨经口气管插管患者合适的口腔护理方法.方法 选取脑外科手术后需停留经口气管插管的患者150例,分为对照组73例与实验组77例,实验组采用冲洗法实施口腔护理,对照组实施传统的口腔护理方法.比较2组患者口腔异味、口腔湿润度及牙菌斑指数情况.结果 实验组的口腔异味发生率、牙菌斑指数显著低于对照组;口腔湿润度显著高于对照组,2组比较差异有统计学意义,P<0.01.结论 口腔冲洗法能有效控制口腔异味了保持患者口腔湿润,有效抑制患者牙菌斑的形成.     

气管插管危重病人口腔护理的研究进展

对目前国内气管插管病人口腔护理方法及效果进行分析,提出建立以循证为基础的气管插管危重病人口腔护理指南及统一的全国性口腔护理规范,使重症监护室的口腔护理有规可行、有据可依,发挥口腔护理对危重病人的最大正性作用。     

Duration of oral endotracheal intubation is associated with dysphagia symptoms in acute lung injury patients

Purpose

The purpose of this study is to evaluate demographic and clinical factors associated with self-reported dysphagia after oral endotracheal intubation and mechanical ventilation in patients with acute lung injury (ALI).

Materials and methods

This is a prospective cohort study of 132 ALI patients who had received mechanical ventilation via oral endotracheal tube.

Results

The primary outcome was binary, whether clinically important symptoms of dysphagia at hospital discharge were reported by patients, using the Sydney Swallowing Questionnaire score 200 or more. Of 132 patients, 29% reported clinically important symptoms of dysphagia. Of 18 relevant demographic and clinical variables, only 2 were found to be independently associated with clinically important symptoms of dysphagia in a multivariable logistic regression model: upper gastrointestinal comorbidity (odds ratio, 2.82; 95% confidence interval, 1.09-7.26) and duration of oral endotracheal intubation (odds ratio, 1.79; [95% confidence interval, 1.15-2.79] per day for first 6 days, after which additional days of intubation were not associated with a further increase in the odds of dysphagia).

Conclusions

In ALI survivors, patient-reported, postexubation dysphagia at hospital discharge was significantly associated with upper gastrointestinal comorbidity and a longer duration of oral endotracheal intubation during the first 6 days of intubation.     

Alternatives to endotracheal intubation for patients with neuromuscular diseases

OBJECTIVE: To evaluate the usefulness of continuous noninvasive mechanical ventilation and mechanical coughing aids to avoid endotracheal intubation and tracheostomy during episodes of acute respiratory failure in patients with neuromuscular disease. DESIGN: We conducted a prospective cohort study at the respiratory medicine ward of a university hospital to study the success rate of the use of continuous noninvasive mechanical ventilation and manually and mechanically (CoughAssist) assisted coughing to avert endotracheal intubation in 24 consecutive episodes of acute respiratory failure for 17 patients with neuromuscular disease. The noninvasive mechanical ventilation and coughing aids were used to reverse decreases in oxyhemoglobin saturation and relieve respiratory distress that occurred despite oxygen therapy and appropriate medication. Noninvasive mechanical ventilation was delivered by volume ventilators (Breas PV 501) alternating nasal/oronasal and oral interfaces. RESULTS: Noninvasive management was successful in averting death and endotracheal intubation in 79.2% of the acute episodes. There were no significant differences in respiratory function between the successfully treated and unsuccessfully treated groups before the current episode. Bulbar dysfunction was the independent risk factor for failure of noninvasive treatment (P < 0.05; odds ratio, 35.99%; 95% confidence interval, 1.71-757.68). CONCLUSIONS: Intubation can be avoided for some patients with neuromuscular disease in acute respiratory failure by some combination of noninvasive mechanical ventilation and mechanically assisted coughing. Severe bulbar involvement can limit the effectiveness of noninvasive management.     

Improving documentation of endotracheal intubation in an adult emergency department

Objective: To evaluate the effect of an educational intervention and documentary pro forma on the adequacy of documentation of intubation in an adult ED. Methods: A structured medical record review was performed before and after a multi‐pronged educational programme and introduction of a specifically designed guide to documentation. Records were assessed for adequacy of documentation by the presence or absence of predetermined elements. Analysis focused on five aspects considered to be most important for future clinical care: drugs and doses used, grade of view, size of endotracheal tube, confirmation of placement and adverse events/difficulties encountered. Results: Sixty‐one and sixty‐eight charts were included in the pre‐intervention and post‐intervention groups, respectively. The drugs and doses used were documented in 92% and 93%. The endotracheal tube size was recorded 82% and 91% of the time. Grade of laryngoscopy was documented in 35% and 46%. Confirmation of endotracheal tube placement was 69% and 84%. Presence or absence of adverse events was recorded in 37% and 54%. All five elements were present in 8.2% and 25% of medical records. Conclusion: Documentation improved slightly following the intervention, but was still unsatisfactory. We believe that to achieve an adequate level of documentation in the medical record for an episode of intubation, there needs to be a formal and structured mechanism, either via mandatory use of a specifically designed form and/or by participation in an organized data registry.     

重复气管插管原因分析及护理对策

目的 分析重复气管插管的原因,寻求对策,以减少呼吸道相关性肺炎的发生。方法 256例患者因病情需要行常规法气管插管。结果 256例患者中,发生重复插管20例,其中气管插管内腔阻塞11例,气管插管脱出5例,气囊漏气1例,患者体型特殊难以插管2例,1例患者因病情变化重复插管4次。结论 熟悉患者病情,熟练插管技术,严密监护患者,防止插管脱出,保持气道湿化,才能减少重复气管插管的发生。     

冲洗法在经口气管插管病人口腔护理的临床应用研究

目的探讨冲洗法在经口气管插管病人口腔护理的效果。方法经口气管插管患者100例,随机分为传统口腔护理组(对照组A组)50例,冲洗法口腔护理组(实验组B组)50例。对两组患者口腔护理后的口腔异味、细菌阳性率、并发症发生率、护理时数进行对比研究。结果实验组患者口腔异味、细菌阳性率、并发症发生率低于对照组,P<0.01。护理时数低于对照组。结论对于经口气管插管患者利用冲洗法能彻底清洁口腔,细菌阳性率明显下降。     

新型专利气管导管在困难气管插管中的临床应用

目的评价本新型专利气管导管在困难气管插管中的临床应用价值。方法随机对73例困难或异常的气道患者分为两组,I组（1／,=73）：在麻醉诱导下,首先采用目前临床上使用的塑料气管导管（传统气管导管）插管,在不用管芯情况下,分析其插管成功率;Ⅱ组（n=63）：在I组2次插管不成功者归为Ⅱ组,并换用新型气管导管插管,在不用管芯情况下分析其插管成功率。结果I组首次插管成功率为2．7％（2／73）,插管总成功率为13．7％（10／73）;11组首次插管成功率为73．02％（46／63）,插管总成功率为98．41％（62／63）,两组首次插管成功率和插管总成功率相比较,差异均有统计学意义（x。值分别为36．01、31．08,P均〈0．01）。结论本新型专利气管导管比传统气管导管有三大优点：具有良好的可塑性,无需辅用气管管芯插管,能充分发挥软导引管的引插管导作用。新型专利气管导管比传统气管导管更加实用。     

首次口腔护理时间对气管插管患者早发性呼吸机相关肺炎发生率的影响

目的探讨首次口腔护理时间对气管插管患者早发性呼吸机相关肺炎(VAP)发生率的影响。方法将入住我院ICU的120例经口气管插管患者随机均分为三组,分别在气管插管后4h内(含4h)、4~8h(含8h)、8~12h(含12h)介入首次口腔护理。比较三组患者早发性呼吸机相关肺炎发生率、机械通气时间、入住ICU时间和病死率等指标。结果三组患者的机械通气时间、入住ICU时间差异有统计学意义,早发性呼吸机相关肺炎发生率、病死率差异无统计学意义。但是,随着首次口腔护理时间的向后推迟,患者的早发性呼肺炎机相关发生率和病死率逐渐升高。结论在插管后4h内介入首次口腔护理,可降低患者的早发性呼吸机相关肺炎发生率与病死率,缩短机械通气时间、入住ICU时间,改善患者预后。     

游离皮瓣修复口腔黏膜缺损术后的口腔护理

口腔颌面部恶性肿瘤根治术常致口腔黏膜大面积缺损，一般需行显微外科游离皮瓣修复。术后除常规观察皮瓣，保持呼吸道通畅外，1周～2周内一般不能经口进食需鼻饲。再者，该类病人口腔自洁功能差以及皮瓣本身臃肿、周围组织肿胀，术后唇、颊、舌、软腭活动度下降。因此，术后有效的口腔护理，不仅有助于口腔清洁，同时对游离皮瓣的一期愈合及口腔功能的恢复均十分重要。自2001年7月至今，我科护理人员对皮瓣修复术后病人运用一套全新的护理方法实施口腔护理，临床疗效显著。现报道如下。     

游离皮瓣修复口腔黏膜缺损术后的口腔护理

口腔颌面部恶性肿瘤根治术常致口腔黏膜大面积缺损,一般需行显微外科游离皮瓣修复.术后除常规观察皮瓣,保持呼吸道通畅外,1周～2周内一般不能经口进食需鼻饲.再者,该类病人口腔自洁功能差以及皮瓣本身臃肿、周围组织肿胀,术后唇、颊、舌、软腭活动度下降.因此,术后有效的口腔护理,不仅有助于口腔清洁,同时对游离皮瓣的一期愈合及口腔功能的恢复均十分重要.自2001年7月至今,我科护理人员对皮瓣修复术后病人运用一套全新的护理方法实施口腔护理,临床疗效显著.现报道如下.……     

Procedural experience with out-of-hospital endotracheal intubation

OBJECTIVE: Out-of-hospital rescuers likely need regular clinical experience to perform endotracheal intubation (ETI) in a safe and effective manner. We sought to determine the frequency of ETI performed by individual out-of-hospital rescuers. DESIGN: Analysis of an administrative database of all emergency medical services (EMS) patient care reports in Pennsylvania. SETTING: Commonwealth of Pennsylvania from January 1 to December 31, 2003. SUBJECTS: EMS advanced life support rescuers (paramedics, prehospital nurses, and EMS physicians) who reported at least one patient contact during the study period. INTERVENTIONS: None. MEASUREMENTS: We calculated individual rescuer ETI frequency and opportunity. We evaluated relationships between ETI frequency and the number of patient contacts. We also examined the relationship with practice setting (air medical vs. ground rescuers and urban vs. rural rescuers). MAIN RESULTS: In 1,544,791 patient care reports, 11,484 ETIs were reported by 5,245 out-of-hospital rescuers. The median ETI frequency was one (interquartile range, 0-3; range, 0-23). Of 5,245 rescuers, >67% (3,551) performed two or fewer ETIs, and >39% (2,054) rescuers did not perform any ETIs. The median number of ETI opportunities was three (interquartile range, 0-6; range, 0-76). ETI frequency was associated with patient volume (Spearman's rho = 0.67) and was higher for air medical (p = .006) and urban (p < .0001) rescuers. ETI frequency was not associated with response (Spearman's rho = -0.01) or transport (Spearman's rho = -0.06) times. CONCLUSIONS: Out-of-hospital ETI, an important and difficult resuscitation intervention, is an uncommon event for most rescuers.     

经口气管插管患者的口腔护理研究进展

探讨经口气管插管病人的口腔护理研究进展.通过回顾国内外文献,综合阐述OETT 患者的口腔护理,不同的护理方法、护理用具各有利弊.在临床上针对个体选择不同的操作方法及护理,以切实提高护理质量.