人工气道内吸痰致气道黏膜损伤的原因分析及护理

气道黏膜损伤是人工气道内吸痰常见并发症之一。笔者经过查阅大量文献结合临床实际总结出，吸痰过频、吸引负压调节不当、吸痰管选择不当、吸痰方法不正确、吸痰时间过长、气道湿化不足等为吸痰导致气道黏膜损伤的常见原因。提出护士应加强吸痰前肺部物理治疗及评估，掌握吸痰时机和顺序，选择适宜的吸引负压及吸痰管，充分气道湿化，掌握正确的吸痰方法和技巧，保护好气道黏膜，降低黏膜损伤发生率。     

重型颅脑损伤患者人工气道吸痰护理的研究进展

总结了重型颅脑损伤患者人工气道吸痰护理措施,包括：吸痰时机、吸痰管、吸痰方式、方法的选择,吸痰时的体位摆放,吸痰时间,气道湿化度等方面。认为适时的吸痰时机,粗细适宜、质地良好的吸痰管,最佳的吸痰方式、方法,配合吸痰时的良好体位,掌握吸痰时间,选择适当的溶液、采用持续气道泵入进行气道湿化,可以有效地保持呼吸道通畅。     

机械通气患儿吸痰护理新进展

综述了机械通气患儿人工气道内吸痰的护理进展,包括吸痰时机的判断、气道湿化、吸痰管的选择、吸痰压力和时间、吸痰方式的选择、吸痰管插入深度以及操作方法和吸痰后的护理,认为正确的吸痰技术是提高护理质量的重要技能,有利于提高抢救成功率。     

1例经气管插管吸痰拔出受阻的原因分析及护理

在护理气管插管病人中,气道内吸痰是最基本、最常规的护理干预措施.有效吸痰,能迅速的清除气道内分泌物,解除气道堵塞的症状.近年来,国内外学者通过对吸痰时机的选择,吸痰管的选择,吸痰方法的改进以及气道湿化等方面的研究和总结,更好的指导了临床护理工作,提高了护理工作效率.我科2012年1月12日给1例气管插管病人吸痰时出现吸痰管拔出受阻,情况非常危急.     

新生儿机械通气的气道管理

气道管理是机械通气治疗新生儿呼吸衰竭成功的关键之一。吸痰前气道湿化、吸痰管的选择、正确拍背、吸痰过程中吸痰方法、吸痰的压力都与吸痰效果密切相关。通过对30例机械通气的新生儿进行合理正确气道管理，取得了良好的效果。     

机械通气病人人工气道内开放式吸痰的研究现状

吸痰是机械通气病人气道管理中最基本、最常规的护理干预措施,从人工气道吸痰时机、吸痰管的选择、吸引负压等方面进行综述,重点分析吸痰导管插入深度、吸痰前滴注生理盐水的安全性和有效性。     

机械通气病人人工气道内开放式吸痰的研究现状

吸痰是机械通气病人气道管理中最基本、最常规的护理干预措施,从人工气道吸痰时机、吸痰管的选择、吸引负压等方面进行综述,重点分析吸痰导管插入深度、吸痰前滴注生理盐水的安全性和有效性。     

人工气道病人吸痰护理的研究进展

从吸痰时机、吸痰管的选择、吸痰方式、吸痰方法及吸痰的影响因素方面对人工气道病人的吸痰护理进行综述，指出目前的人工气道内吸痰研究领域中还存在大量的护理问题，有待深入实践及循证可靠的科学依据支持，使吸痰护理操作日臻完善。     

人工气道病人吸痰的护理研究进展

从吸痰时机、吸痰管的选择、吸痰负压、吸痰深度、湿化方法等方面对人工气道病人的吸痰护理进行综述,指出目前相关理论及进展,阐明了正确吸痰的重要性。     

液状石蜡在经鼻腔吸痰中的应用

在经鼻腔吸痰中使用无菌液状石蜡润滑吸痰管前端,提高了吸痰效果.现介绍如下. 1 材料与方法 经高温消毒的无菌液状石蜡1瓶,无菌棉签、一次性吸痰管1根(根据病人的年龄选择合适的吸痰管),无菌手套.戴无菌手套取出无菌吸痰管,用无菌棉签蘸无菌液状石蜡润滑吸痰管前端10 cm～14 cm,畅通呼吸道,将吸痰管从鼻腔轻轻插入病人的气道,吸出呼吸道的痰液及鼻咽腔的分泌物.可用于呼吸道分泌物多且无人工气道又无力咳痰的病人.     

两种气道内深部吸痰方法的效果观察及护理

目的探讨两种气道内深部吸痰方法的效果。方法将40例清理呼吸道无效、抗拒吸痰的患者,根据吸痰方法分为观察组21例,对照组19例。两组均用口咽通气管建立临时气道,对照组用普通枕头垫高肩部(≤10cm)后行气道内深部吸痰;观察组用吸痰枕垫高肩部15cm后行气道内深部吸痰。观察记录两组患者吸痰效果(吸痰次数、吸痰量)和气道黏膜损伤情况。结果观察组气道黏膜损伤发生率低于对照组;每日吸痰次数较对照组少;每次吸痰量较对照组多,两组比较,均P0.05,差异具有统计学意义。结论采用肩部抬高15cm,暂时留置吸痰管等方法行气道内深部吸痰,可提高吸痰效果和降低气道黏膜损伤的发生。     

密闭式浅层吸痰在机械通气中的应用效果研究

[目的]探讨实施不同的吸痰方式和吸痰深度对机械通气病人的效果,为临床选择安全、有效的吸痰方式提供依据。[方法]将40例行机械通气的病人随机分成两组,观察组采用密闭式浅层吸痰（吸痰管超过气管导管前端1 cm）,对照组采用临床常规开放式吸痰（即吸痰管插入气管遇到阻力后上提0.5 cm ~1.0 cm 后吸引）,比较两组病人吸痰前后血氧饱和度（SpO 2）、心率（HR）、呼吸频率（R）、潮气量（VT）、平均气道压（Pmean）的变化以及对气道黏膜的损伤等并发症的影响。[结果]观察组病人采用密闭式浅层吸痰后引起呼吸循环变化幅度及气道黏膜损伤程度明显优于对照组,差异有统计学意义（P 〈0.05）。[结论]病人机械通气期间行密闭式浅层吸痰能降低机体的应激反应,减少对气道的刺激及吸痰并发症,是一种安全有效的吸痰方式。     

听诊结合吸痰管刺激吸痰法对机械通气患者动脉血气的影响

目的:探讨听诊结合吸痰管刺激吸痰法对机械通气患者动脉血气的影响。方法:将62例患者随机分为观察组与对照组各31例。对照组患者有明显痰鸣音时或呼吸机气道峰压升高报警立即给予吸痰,观察组患者采用听诊结合吸痰管刺激吸痰法。比较两组患者吸痰前、吸痰结束时、吸痰后5 min动脉血气变化;吸痰前后血压、心率变化;平均吸痰量、机械通气时间、住院天数、住院费用、呼吸机相关性肺炎发生情况。结果:观察组患者吸痰前后PaO2、SaO2均处于高值,影响不明显,PaCO2较对照组患者下降明显,对照组患者吸痰前后PaO2、SaO2波动明显;两组患者吸痰前后血压、心率变化比较差异无统计学意义(P>0.05);平均吸痰量、机械通气时间、住院天数、住院费用、呼吸机相关性肺炎发生情况比较差异有统计学意义(P<0.01)。结论:为机械通气患者实施听诊结合吸痰管刺激吸痰能有效提高血氧含量,预防因气道阻塞时间长致机体缺氧造成的各种并发症,减少呼吸道黏膜损伤。     

神经外科气管切开病人吸痰方法的探讨

[目的]探讨分步吸痰法在神经外科气管切开病人中的应用效果。[方法]将80例气管切开病人随机分为对照组和观察组,对照组采用常规吸痰法,观察组采用分步吸痰法。比较两组病人的日吸痰次数、吸痰效果、气道黏膜损伤、不同时间肺部感染、吸痰前和吸痰后5 min血氧饱和度(SpO2)。[结果]与对照组比较,观察组日吸痰次数减少,且对气道黏膜损伤小,吸痰后SpO2明显升高,差异有统计学意义(P<0.01)。[结论]分步吸痰法在神经外科气管切开病人的护理中,吸痰效果明显优于常规吸痰法,损伤小,并发症少,安全有效。     

Commentary: Morrow B, Futter M, Argent A. (2006). Effect of endotracheal suction on lung dynamics in mechanically-ventilated paediatric patients

Endotracheal suctioning is performed regularly in ventilated infants and children to remove obstructive secretions. The effect of suctioning on respiratory mechanics is not known. This study aimed to determine the immediate effect of endotracheal suctioning on dynamic lung compliance, tidal volume and airway resistance in mechanically ventilated paediatric patients by means of a prospective observational clinical study. Lung mechanics were recorded for 5 min before and 5 min after a standardized suctioning procedure in 78 patients intubated with endotracheal tubes of ≤4·0 mm internal diameter. Twenty‐four patients with endotracheal tube leaks ≥20% were excluded from analysis. There was a significant overall decrease in dynamic compliance (p < 0·001) and mechanical expired tidal volume (p = 0·03) following suctioning with no change in the percentage of endotracheal tube leak (p = 0·41). The change in dynamic compliance was directly related to both endotracheal tube and catheter sizes. There was no significant change in expiratory or inspiratory airway resistance following suctioning (p > 0·05). Although most of the patients (68·5%) experienced a drop in dynamic compliance following suctioning, dynamic compliance increased in 31·5% of patients after the procedure. This study demonstrates that endotracheal suctioning frequently causes an immediate drop in dynamic compliance and expired tidal volume in ventilated children with variable lung pathology, intubated with small endotracheal tubes, probably indicating loss of lung volume caused by the suctioning procedure. There is no evidence that suctioning reduces airway resistance. Abstract reprinted from the Australian Journal of Physiotherapy volume 52, Morrow B et al., ‘Effect of endotracheal suction on lung dynamics in mechanically‐ventilated paediatric patients’, pages 121–126. © 2006, reproduced with permission from the Australian Physiotherapy Association.     

New endotracheal tube adaptor reducing cardiopulmonary effects of suctioning

The continuous recordings of arterial oxygen saturation (SaO2) and beat-to-beat heart rate before, during, and after tracheobronchial suctioning were studied in eight preterm infants with severe RDS receiving mechanical ventilation. Two suctioning procedures were alternatively performed in each infant; In procedure A, disconnection of the ventilator and preoxygenation preceded suctioning; in procedure B, a special suction adaptor was used without ventilatory interruption or preoxygenation; 128 suctionings were performed with each procedure and the changes in heart rate (HR) and SaO2 during suctioning were compared. Although in both procedures, HR and SaO2 decreased during suctioning, the degree of bradycardia and arterial blood oxygen desaturation were significantly smaller in magnitude and shorter in duration during procedure B. These data indicate advantages of the suction adaptor in minimizing bradycardia and hypoxia from airway suction.     

Suctioning via the tube during endotracheal intubation in a model of severe upper airway haemorrhage: is there an advantage vs. suctioning with a separate catheter?

Introduction

In a model of severe simulated upper airway haemorrhage, we compared two techniques of performing endotracheal intubation: (1) suctioning via the endotracheal tube during laryngoscopy with subsequently advancing the endotracheal tube, and (2) the standard intubation strategy with performing laryngoscopy, and performing suction with subsequently advancing the endotracheal tube.

Methods

Forty-one emergency medical technicians intubated the trachea of a manikin with severe simulated airway haemorrhage using each technique in random order.

Results

There was no significant difference in the number of oesophageal intubations between suctioning via the tube and the standard intubation strategy [8/41 (20%) vs. 6/41 (15%); P = 0.688], but suctioning via the endotracheal tube needed significantly more time [median (IQR, CI 95%): 42 (20, 39-60) vs. 33 (15, 35-48) s; P = 0.015].

Conclusions

Suctioning via the endotracheal tube showed no benefit regarding the number of oesophageal intubations and needed more time when compared to the standard intubation strategy.     

纤维支气管镜吸痰结合浅部吸痰方式对ICU病房人工气道患者肺通气及肺部感染的影响

目的 通过将纤维支气管镜(FB)吸痰方式结合浅部吸痰方式进行气道管理与传统吸痰管理方式进行对比，旨在探讨对ICU人工气道患者采取不同吸痰护理方案护理效果。方法 随机抽取2017年4月至2018年12月江南大学附属医院入住ICU并建立人工气道行机械通气辅助治疗患者86例进行研究，按照吸痰护理方案不同分为2组，行FB吸痰与浅部吸痰相结合的吸痰护理管理患者为研究组，行常规吸痰护理管理患者为对照组，对建立人工气道患者第1 d、7 d动脉血气指标及呼吸力学指标进行分析，统计患者气道粘膜损伤、肺部感染情况的发生率。结果 建立人工气道第1 d两组患者P动脉血气指标及呼吸力学指标差异均无统计学意义（P>0.05）；建立人工气道第7 d研究组患者PaO2与SaO2以及PIP显著升高，PaCO2与Pplat、mPaw 、Raw显著降低，且变化范围均远优于对照组（均P<0.05）。研究组发生气道黏膜损伤与肺部感染发生率（16.27%、18.60%）均显著低于对照组（67.44%、46.51%）（均P<0.05）。结论 采用FB吸痰结合浅部吸痰护理方案对ICU人工气道患者进行干预可提升呼吸道管理质量，有效改善患者呼吸功能，减少气道黏膜损伤与肺部感染发生，具有较高的临床实践价值。     

Effect of endotracheal suction on lung dynamics in mechanically-ventilated paediatric patients

Endotracheal suctioning is performed regularly in ventilated infants and children to remove obstructive secretions. The effect of suctioning on respiratory mechanics is not known. This study aimed to determine the immediate effect of endotracheal suctioning on dynamic lung compliance, tidal volume, and airway resistance in mechanically-ventilated paediatric patients by means of a prospective observational clinical study. Lung mechanics were recorded for five minutes before and five minutes after a standardised suctioning procedure in 78 patients intubated with endotracheal tubes < or = 4.0 mm internal diameter. Twenty-four patients with endotracheal tube leaks > or = 20% were excluded from analysis. There was a significant overall decrease in dynamic compliance (p < 0.001) and mechanical expired tidal volume (p = 0.03) following suctioning with no change in the percentage endotracheal tube leak (p = 0.41). The change in dynamic compliance was directly related to both endotracheal tube and catheter sizes. There was no significant change in expiratory or inspiratory airway resistance following suctioning (p > 0.05). Although the majority of patients (68.5%) experienced a drop in dynamic compliance following suctioning, dynamic compliance increased in 31.5% of patients after the procedure. This study demonstrates that endotracheal suctioning frequently causes an immediate drop in dynamic compliance and expired tidal volume in ventilated children with variable lung pathology, intubated with small endotracheal tubes, probably indicating loss of lung volume caused by the suctioning procedure. There is no evidence that suctioning reduces airway resistance.     

Patient recollection of airway suctioning in the ICU: routine versus a minimally invasive procedure

OBJECTIVE: Many patients have an unpleasant recollection of routine endotracheal suctioning after discharge from the Intensive Care Unit (ICU). We hypothesized that through minimally invasive airway suctioning discomfort and stress may be prevented, resulting in less recollection. DESIGN: A prospective randomized clinical trial. SETTING: Two ICUs at the University Hospital of Groningen, the Netherlands. PATIENTS AND PARTICIPANTS: Adult patients with an intubation period exceeding 24 h were included. INTERVENTIONS: Patients received either routine endotracheal suctioning (RES) or minimally invasive airway suctioning (MIAS) during the duration of intubation. MEASUREMENTS AND RESULTS: Within 3 days after ICU discharge all patients were interviewed, regarding recollection and discomfort of suctioning. The level of discomfort was quantified on a visual analogue scale (VAS). We analyzed data from 208 patients (RES: n=113, and MIAS: n=95). A significantly lower prevalence of recollection of airway suctioning was found in the MIAS group (20%) compared to the RES group (41%) (P-value =0.001). No significant difference in level of discomfort was found between the RES and the MIAS group (P-value =0.136). CONCLUSIONS: Minimally invasive airway suctioning results in a lower prevalence of recollection of airway suction than in RES, but not in discomfort.