Patient Preference for ln-Exsufflation for Secretion Management with Spinal Cord Injury

Abstract

An important aspect of respiratory management in patients with acute spinal cord injury (SCI) is the elimination of secretions. Methods utilized for secretion management in patients with SCI includes endotracheal suctioning and mechanical in-exsufflation (MI-E). Surveyed here is a group of patients with SCI who have had experience with both endotracheal suctioning and MI-E via tracheostomy, to determine patient opinions and experiences regarding the 2 techniques. The survey was administered to 18 patients with traumatic SCI, with an average age of 34. 72% were ASIA A, 22% percent were ASIA B, and 6% were ASIA C, with neurological level of injury ranging from C-1-T-3. Results indicate that patients found MI-E significantly less irritating (p < 0.001 ), less painful (p < 0.001 ), less tiring (p = 0.01 ), and less uncomfortable (p < 0.001) than endotracheal suctioning. In a direct comparison, 89% of patients preferred mechanical in-exsufflation to suctioning. In addition, 89% of patients found MI-E faster, 78% found MI-E more convenient, and 72% found MI-E more effective than suctioning. This study demonstrates that all measured aspects of patient experience are more positive for MI-E than for endotracheal suctioning.     

不同吸痰方式对颅脑损伤患者肺功能及肺感染的影响

目的分析不同吸痰方式对于颅脑损伤患者肺功能及肺感染的影响。方法 2012-10-2013-03于我院住院治疗的重型颅脑损伤患者63例,随机分为联合吸痰组(32例)和常规吸痰组(31例),分析联合吸痰组和常规吸痰组心率、呼吸次数、日吸痰量、痰黏稠度、不同时间氧分压、二氧化碳分压、PaO2/FiO2、黏膜出血发生率及肺部感染发生率。结果联合吸痰组和常规吸痰组心率及呼吸次数差别无统计学意义(P0.05);联合吸痰组的日吸痰量为(85.71±4.13)mL,常规吸痰组的日吸痰量为(62.26±6.97)mL,联合吸痰组的日吸痰量显著高于常规吸痰组(P0.05);联合吸痰组的痰液黏稠度显著低于常规吸痰组(P0.05);联合吸痰组第1、3、7天的氧分压、PaO2/FiO2均显著高于常规吸痰组(P0.05),二氧化碳分压显著低于常规吸痰组(P0.05);联合吸痰组的黏膜出血发生率及肺部感染发生率显著低于常规吸痰组(P0.05)。结论支气管镜灌洗联合浅部吸痰能够改善颅脑损伤患者的通气、换气功能,减少气道黏膜损伤,控制肺部感染,护理工作离不开临床医师配合,支气管镜灌洗联合浅部吸痰用于颅脑损伤患者是新型护理与临床结合的模式。     

The effect of foot reflexology before suctioning on pain and SPO2 in neonates under nasal CPAP hospitalized in the NICU

IntroductionSuctioning procedures in neonates under nasal CPAP and the use of reflexology as a non-invasive method are inevitable. Accordingly, this study aims to determine the effect of foot reflexology before suctioning on pain and SPO2 in neonates under nasal CPAP, who were admitted to the neonatal intensive care unit (NICU).MethodsThis quasi-experimental crossover study was conducted among 40 neonates under nasal CPAP, who were admitted to the NICU of Ali Ibn Abitaleb Hospital in Rafsanjan, Southeastern Iran. The neonates were divided into one of two groups (A and B), according to the inclusion criteria. Neonates in group A received foot reflexology for 3 min during the first suctioning. The second round of suctioning was performed without the reflexology intervention in this group. In group B, the order of applying reflexology was opposite to that in the group A. Before and after suctioning, SPO2 was recorded as shown by the monitor. During the suctioning procedure, pain was assessed using the NIPS tool. In addition, data were analyzed using SPSS Software.ResultsBased on the results, the mean score of pain was lower in the two groups after suctioning with reflexology (the paired t-test, p < 0.05). Although suctioning improved SPO2, reflexology had no effect on this indicator (p > 0.05).ConclusionReflexology before suctioning is effective in reducing pain in neonates. Additional studies are recommended on changing the time and duration of reflexology and examining the effects.     

昏迷患者应用口咽通气管吸痰的护理体会

目的经口咽通气管建立起来的人工气道吸痰法,克服影响经鼻吸痰效果的因素,解决经鼻吸痰中存在的问题,有效清除昏迷病人气道分泌物。方法对13例昏迷患者采用了经口咽通气管辅助吸痰护理。结果13例昏迷患者均未因痰液堵塞而发生窒息,呼吸道梗阻症状明显改善、血氧饱和度由原来的90%以下上升到95%以上。结论昏迷患者口腔放置口咽通气管辅助吸痰,操作方法简便、易于掌握,它是一种能够在数秒钟内迅速获得通气的方法,不仅可以保持呼吸道通畅,纠正缺氧,降低脑损害,还可以避免舌后坠,减轻脑水肿,避免脑损害的发生。此方法是清除痰液潴留,改善通气功能,控制肺部感染的一项积极、有效的护理措施。     

两种气管内吸引术在重型颅脑伤患者中的应用比较

目的比较开放式气管内吸引术(Open endotracheal suctioning,Open ETS)与闭合式气管内吸引术(Closed endotracheal suctioning,Closed ETS)对重型颅脑伤患者平均动脉压(MAP)、颅内压(ICP)、脑灌注压(CPP)等方面的影响及其意义。方法将32例重型颅脑伤患者随机分成Open ETS组(n=16)和Closed ETS组(n=16),于吸引前、后动态监测MAP、ICP、CPP变化。结果两组患者吸引后即时MAP均升高,Open ETS组较Closed ETS组明显(P<0.05)。吸引后即时ICP均短暂升高,两组变化趋势基本相同,大多于5min内回落。吸引后即时Open ETS组CPP下降(P<0.01),而Closed ETS组CPP变化无统计学意义。结论颅内高压状态下OpenETS可引起脑缺血、缺氧反应,而Closed ETS不损害脑灌注,并可维持足够脑氧供。因Closed ETS更具合理性,故建议颅脑外伤后可运用Closed ETS。     

有效吸痰预防呼吸机相关性肺炎的研究进展

呼吸机相关性肺炎(VAP)是机械通气患者最常见的一种严重并发症.它指患者通过气管插管或气管切开行机械通气48h后发生的医院获得性肺炎[1].气管插管抑制咳嗽反射并破坏呼吸道正常的黏液纤毛运动,导致痰液潴留,而痰液又是细菌滋长的媒介,从而增加了患者VAP发生的风险.     

改良式拍背吸痰在呼吸机治疗重症肺炎患儿中的疗效研究

目的探讨改良式拍背后吸痰在婴幼儿重症肺炎应用呼吸机患儿治疗中的疗效。方法选择应用呼吸机治疗的小儿重症肺炎60例,随机分成对照组30例和实验组30例。实验组采用改良式拍背后吸痰,对照组采用常规式拍背后吸痰,比较两组患儿吸痰前后血氧分压（PaO2）、二氧化碳分压（PaCO2）的变化及临床疗效。结果两组患儿吸痰前PaO2、PaCO2的差异无统计学意义（P〉0．05）;吸痰后实验组PaO2（58．57±12．41）mmHg,PaCO2（42．76±10．51）mmHg,对照组PaO2（51．31±12．32）minHg,PaC02（48．98±9．86）mmHg,实验组吸痰前后血气测定的改善情况优于对照组,疗效优于对照组,差异均有统计学意义（P〈0．05）。结论采用改良式拍背后吸痰,能明显缩短重症肺炎的患儿使用呼吸机的时间及病程,提高了小儿重症肺炎的治愈率。     

昏迷患者应用口咽通气管吸痰的护理体会

目的经口咽通气管建立起来的人工气道吸痰法，克服影响经鼻吸痰效果的因素，解决经鼻吸痰中存在的问题，有效清除昏迷病人气道分泌物．方法对13例昏迷患者采用了经口咽通气管辅助吸痰护理。结果13例昏迷患者均未因痰液堵塞而发生窒息，呼吸道梗阻症状明显改善、血氧饱和度由原来的90％以下上升到95％以上。结论昏迷患者口腔放置口咽通气管辅助吸痰．操作方法简便、易于掌握，它是一种能够在数秒钟内迅速获得通气的方法，不仅可以保持呼吸道通畅，纠正缺氧，降低脑损害，还可以避免舌后坠，减轻脑水肿，避免脑损害的发生。此方法是清除痰液潴留，改善通气功能，控制肺部感染的一项积极、有效的护理措施。     

ICU坠积性肺炎患者经口咽通气道声门下吸痰的疗效观察

目的：探讨经口咽通气道声门下吸痰对坠积性肺炎患者的疗效。方法选取IC U坠积性肺炎患者30例,按入院序号分为观察组与对照组,每组15例。观察组采用经口咽通气道声门下痰吸引,对照组采用咽喉部痰吸引,对两组患者一周内的咳嗽反射、气管插管率或气管切开率、吸痰总量及次数、血氧饱和度（SpO2）和血氧分压（PaO2）的情况进行统计和观察。结果两组一周内SpO2、PaO2、吸痰总量及次数、咳嗽反射、气管插管率或气管切开率差异均有显著意义（P＜0．05）。结论对坠积性肺炎患者采用经口咽通气道声门下吸痰,不仅可以有效改善患者的低氧血症,减少咳嗽反射,增加患者舒适度,还可以减少吸痰次数,减轻护士工作量。