气管插管前口腔消毒准备与术后呼吸道感染的相关性研究

人体口腔中存有正常菌群或致病菌 ,而下呼吸道是无菌的[1] 。而有些手术常需要全麻经口腔气管插管 ,这样在插管时 ,势必将口腔中的致病菌带入下呼吸道成为致病源 ,导致不少病人咽喉疼痛、咳嗽、咯痰等呼吸道感染症状。口腔消毒能否起到预防作用 ,对此我们进行了深入的探讨和研究。1　资料与方法1 1　一般资料。随机选择ＡＳＡⅠ～Ⅱ级的普胸外科病人 6 2例 ,男性 4 6例 ,女性 16例 ,年龄 2 2～ 78岁 ,体重 5 5～ 78ｋｇ ,以食管癌和贲门癌病人为主 ,术前均无咳嗽、咯痰、咽痛等呼吸道感染征象 ,将其单盲法分为 2组 ,即实验组 (31例 )和对照…     

两种口腔护理方法用于经口气管插管病人口咽部细菌定植的比较

探讨改良口腔护理方法对气管插管病人口咽部细菌定植的影响。将处于同样条件的病人随机分为对照组和实验组,分别采取传统方法和改良方法进行口腔护理,分别留取标本进行检验。改良组口咽部细菌数量明显少于传统组。改良式口腔护理方法应用于经口气管插管病人,可以有效地减少口咽部细菌定植的数量,减少院内感染的发生。     

ICU患者经口气管插管与经鼻气管插管后行气管切开的比较

目的探讨经口气管插管与经鼻气管插管在ICU留置时间,比较两组气管插管后行气管切开的比例。方法将42例气管插管患者随机分为经口气管插管组24例和纤维支气管镜引导下经鼻气管插管组18例,比较两组患者插管留置时间及插管后再行气管切开率。结果经鼻气管插管留置时间明显长于经口气管插管,经鼻气管插管后行气管切开的比例明显低于经口气管插管。结论纤维支气管镜引导经鼻气管插管在ICU是有效的,插管留置时间更长,部分经鼻气管插管患者避免行气管切开。     

呼吸道消毒护理预防气管插管口咽不适与感染的临床研究

目的:探讨全庥插管患者的口咽舒适度及呼吸道感染的预防.方法:将120例手术插管患者随机分为观察组和对照组各60例.观察组于患者入室后麻醉前用自配漱口水漱口3次,每次30 s～1 min.咽喉部喷雾3次,剩余的漱口水用来冲洗吸痰管,术中术后吸痰,通过吸痰管吸附,把漱口水带入气管.对照组不予漱口及喷雾,吸痰用0.9%氯化钠冲洗吸痰管.两组于术前及术后分别行舌面、咽喉部及导管气囊末端附着物培养.结果:观察组与对照组标本培养结果比较有显著性差异(P＜0.05);口咽舒适度比较有高度显著性差异(P＜0.01).结论:全麻气管插管患者采用自配漱口水行口咽气管全程护理,能提高口咽舒适度及局部抑菌、杀菌的作用,减少呼吸道感染的机会.     

口腔护理频次对经口气管插管患者口腔细菌植入的影响

目的探讨经口气管插管行机械通气患者口腔护理的适宜频次。方法将经口气管插管行机械通气的50例患者随机分为A、B、C三组,三组的口腔护理频次分别为每日3次、4次、6次,采用复方氯己定含漱液行口腔擦洗法护理口腔,于插管后的第一个和第三个14∶00或15∶00的口腔护理前分别留取口咽部及鼻咽部分泌物,进行细菌菌落计数,同时观察患者口腔溃疡及口臭情况。结果 3组之间口腔溃疡、口臭清除率、口腔细菌菌落清除率(其中A组与B组、A组与C组口咽部细菌清除率有差异,B组与C组口咽部细菌清除率无差异)均存在差异,且有统计学意义(P0.05)。结论推荐在临床护理过程中,给予经口气管插管行机械通气患者每日4次口腔护理,这能有效清除已发生的溃疡和口臭,降低口咽部细菌定植,预防VAP发生。     

聚维酮碘在经口机械通气病人口腔护理中的应用

目的：探讨0．5％聚维酮碘溶液在经口机械通气病人口腔护理中的效果。方法：将60例经口机械通气病人随机分为实验组和对照组各30例,实验组用0．5％聚维酮碘溶液进行口腔护理,对照组用生理盐水进行口腔护理,比较两组口腔护理的效果。结果：病人口腔异味发生率、细菌培养阳性率、呼吸机相关性肺炎发生率实验组为：23．33％、16．67％、6．67％,对照组为：53．33％、43．33％、40．00％,两组口腔护理效果比较有显著性差异（P〈0．05,P〈0．01）。结论：0．5％聚维酮碘溶液应用于经口机械通气病人口腔护理中能有效降低呼吸机相关性肺炎的发生。     

两种口腔护理方法用于经口气管插管病人口咽部细菌定植的比较

探讨改良口腔护理方法对气管插管病人口咽部细菌定植的影响。将处于同样条件的病人随机分为对照组和实验组，分别采取传统方法和改良方法进行口腔护理，分别留取标本进行检验。改良组口咽部细菌数量明显少于传统组。改良式口腔护理方法应用于经口气管插管病人，可以有效地减少口咽部细菌定植的数量，减少院内感染的发生。     

预防气管插管意外拔管的护理干预

目的总结预防气管插管意外拔管的护理干预。方法对2006年2月至2007年3月间预防39例气管插管患者意外拔管的护理干预进行回顾性分析。结果无1例发生意外拔管，减轻了患者的痛苦。结论通过对气管插管牢固固定，做好气道管理，对患者合理约束、加强心理护理及必要的镇静，能避免气管插管意外拔管的发生。     

Retrograde technique for tracheal intubation in trauma patients

Nineteen trauma patients with either maxillofacial trauma or cervical spine fracture were orotracheally intubated over a guidewire percutaneously inserted through the cricothyroid membrane into the mouth in a retrograde fashion. In 13 patients, conventional techniques failed (average number of attempts 6 +/- 1, mean duration 18 +/- 1 min); in six patients, the initial method of choice was a retrograde technique. In all patients, retrograde technique succeeded on only one attempt (duration less than 5 min in all cases). No serious complication could be related to this technique; it is an easy, safe, efficacious method for difficult tracheal intubation in trauma patients.     

Noncardiac pulmonary edema precipitated by tracheal intubation in patients with inhalation injury

Ten patients with body surface burn and clinical evidence of inhalation injury developed transient, reversible pulmonary edema within 5 min after endotracheal intubation. Hemodynamic studies within 1 hr after intubation revealed normal cardiac output and pulmonary artery wedge pressure (WP). Additionally, in the latter 4 patients, protein concentration of edema fluid (EF) aspirated from the trachea was 58-104% of plasma (P) total protein. These findings suggest that altered capillary permeability was responsible for this transient pulmonary edema. It is postulated that glottic generated expiratory retard may increase alveolar pressure, thus preventing pulmonary edema. Bypass of glottis by tracheal intubation may render alveolar pressure atmospheric and facilitate edema formation.     

清醒气管插管患者非镇静状态时的护理

<正>气管插管作为建立和保持呼吸道通畅的一项重要手段,临床上常常会用于意识清醒的患者。由于气管插管及自身疾病所带来的痛苦,患者极易出现烦躁,导致意外拔管。据研究显示,气管插管非计划性拔管发生率高达10.8%～22.5%,其中87.5%～96%属于自行拔管。临床上为了防止非计划性拔管的发生,对于清醒患者必须使用镇静剂才能达到治疗目的。但长期使用镇静药物可致药物蓄积,过度镇静还可导致患者咳嗽和排痰能力减弱,影响呼吸功能恢复和气道分泌物消除,增加肺部感     

Preoxygenation in critically ill patients requiring emergency tracheal intubation

OBJECTIVE: To determine the effectiveness of preoxygenation with 100% oxygen in the critically ill patient in preparation for emergency tracheal intubation. DESIGN: Nonrandomized, controlled trial. SETTING: Large, level 1 trauma center, tertiary care intensive care unit. PATIENTS: Critically ill patients failing noninvasive respiratory support techniques who require tracheal intubation followed by mechanical ventilation. INTERVENTIONS: A baseline arterial blood gas was obtained on noninvasive therapy and 4 mins post-100% oxygen therapy with a bag-mask assembly. Best effort to achieve a tight-fitting mask seal was pursued coupled with other mask ventilation maneuvers to optimize noninvasive oxygenation and ventilation. MEASUREMENTS AND MAIN RESULTS: A total of 42 patients consecutively intubated during the 15-month study period were studied. The baseline Pao2 (mean +/- sd) with concurrent noninvasive support was 67 +/- 19.6 mm Hg (range, 43-88 mm Hg) and increased a mean of 37 mm Hg to 103.8 +/- 63.2 mm Hg after 4 mins of preoxygenation with 100% oxygen. A total of 36% of patients had minimal changes (+/-5%) in their baseline Pao2, and only 19% increased their baseline Pao2 by at least 50 mm Hg after preoxygenation maneuvers. CONCLUSIONS: The critically ill patient has little reserve to tolerate interruption of oxygen delivery and, thus, is at risk for hypoxemia during emergency airway management. Preoxygenation efforts as described in this clinical trial appear to be marginally effective in regard to providing a reasonable safeguard against hypoxemia during laryngoscopy and endotracheal intubation.     

经鼻纤维支气管镜引导下气管插管在阻塞性呼吸暂停综合征病人手术中的应用

目的 探讨经鼻纤维支气管镜引导气管内插管在OSAS病人手术中的效果和安全性。方法 回顾性分析53例采用表面麻醉，环甲膜穿刺注药，静脉点滴少量镇痛药物和纤维支气管引导下气管内插管的临床资料。结果 一次插管成功51例，二次插管成功2例，插管时血压升高者11例，心率增快者15例，血氧饱和度下降者7例，压迫气管导管者5例，导管扭曲1例，经调整导管恢复正常。结论 纤维支气管引导下气管内插管施行UPPP插管成功率高，病人痛苦小，效果肯定，术中较为安全。     

Noninvasive mechanical ventilation in patients having declined tracheal intubation

Purpose

Noninvasive ventilation (NIV) is a treatment option in patients with acute respiratory failure who are good candidates for intensive care but have declined tracheal intubation. The aim of our study was to report outcomes after NIV in patients with a do-not-intubate (DNI) order.

Methods

Prospective observational cohort study in all patients who received NIV for acute respiratory failure in 54 ICUs in France and Belgium, in 2010/2011.

Results

Goals of care, comfort, and vital status were assessed daily. On day 90, a telephone interview with patients and relatives recorded health-related quality of life (HRQOL), posttraumatic stress disorder-related symptoms, and symptoms of anxiety and depression. Post-ICU burden was compared between DNI patients and patients receiving NIV with no treatment-limitation decisions (TLD). Of 780 NIV patients, 574 received NIV with no TLD, and 134 had DNI orders. Hospital mortality was 44 % in DNI patients and 12 % in the no-TLD group. Mortality in the DNI group was lowest in COPD patients compared to other patients in the DNI group (34 vs. 51 %, P = 0.01). In the DNI group, HRQOL showed no significant decline on day 90 compared to baseline; day-90 data of patients and relatives did not differ from those in the no-TLD group.

Conclusions

Do-not-intubate status was present among one-fifth of ICU patients who received NIV. DNI patients who were alive on day 90 experienced no decrease in HRQOL compared to baseline. The prevalences of anxiety, depression, and PTSD-related symptoms in these patients and their relatives were similar to those seen after NIV was used as part of full-code management (clinicaltrial.govNCT01449331).     

应用牵拉气管法为气管插管病人留置胃管的临床观察

人工气道是将导管经口或鼻腔插入气管或气管切开置入套管所建立的气体交换通道。急危重病人建立人工气道后,一般都需留置胃管进行消化道监测或肠内营养支持。由于气管导管及气囊的压迫间接引起食管狭窄甚至使入口闭塞,并且病人处于镇静或昏迷状态,无自主吞咽动作,采用气囊放气和前倾头部置胃管一次成功率较低。为减少反复插胃管给病人带来的痛苦及不良反应,仔细分析气管与食管的解剖特点,总结出一种简易可行的留置胃管方法,即当胃管置入14cm~16cm(咽喉部)时,一手轻轻向上牵拉气管,另一手迅速将胃管置入10cm,使其通过食管的狭窄处后,再按常规…     

人工鼻在CCU气管插管患者中的应用

目的探讨人工鼻在CCU气管插管患者中的应用效果。方法将62例气管插管患者随机分为人工鼻组（n=32例）与电热恒温湿化组（n=32例）,比较两组患者痰液黏稠度、刺激性呛咳、气道管理耗时数、平均插管时间、气道耗材费用、呼吸机相关肺炎发生率等情况。结果人工鼻组发生刺激性呛咳28．1％、呼吸机相关肺炎发生率15．6％、气道管理耗时数（2．3±0．5）h、平均插管时间（112±6．5）h、气道耗材费用（44．2±6．7）元均优于电热恒温湿化组71．9％,37．5％,（3．5±0．6）h,（133±7．8）h,（56．3±1．5）元,差异均有统计学意义（X2分别为12.25,3．9250;t分别为8．6605,11．6998,8．2129;P〈0.01或P〈0.05）;人工鼻组痰液黏稠度Ⅰ度12．5％,Ⅱ度62．5％,Ⅲ度25．0％,电热恒温湿化组Ⅰ度46．9％,Ⅱ度25．0％,Ⅲ度28．1％,两组比较差异具有统计学意义（x2=11．5590,P〈0．01）。结论人工鼻应用于气管插管患者,可达到理想的气道湿化效果,并能有效提高气道管理效能,省时节力,降低呼吸机相关肺炎发生率,可在临床推广应用。