拍背对重症颅脑损伤患者气管切开气囊压力的影响

目的：观察拍背对重症颅脑损伤患者气管切开气囊压力的影响。方法：选取2012年7月-2013年7月在本院ICU住院的30例重症颅脑损伤并气管切开的患者,采用专用气囊压力表测量气囊压力,分别在三餐前30 min及三餐后2 h由同一名护士进行拍背,观察比较拍背前后平均气囊压力变化和不良反应发生情况。结果：共观察记录90例次拍背前后气囊压力。拍背后气囊压力无变化者6例次,占6.7%,有变化者占84例,占93.3%。拍背后平均气囊压力（25±3.6）cm H2O明显低于拍背前的（28±2.4）cm H2O,差异有统计学意义（t=4.128,P〈0.01）。拍背后的不良反应发生率26.7%明显低于拍背前的96.7%,差异有统计学意义（t=31.093,P〈0.01）。结论：在拍背后应注意监测气囊压力,调整气囊容积,以保持最佳的气囊压力,减少不良反应,从而防止气囊漏气及吸入性肺炎的发生。

The Influence of Pressure in Airbag When Knocking the Back to Severe Craniocerebral Injury Patients Combined with Tracheotomy

Objective：To observe the influence of pressure in airbag when knocking the back to severe craniocerebral patients combined with tracheotomy.Method：30 severe craniocerebral injury patients combined with tracheotomy in our ICU department from July 2012 to July 2013 were selected,pressure in airbag were measured by special air pressure gauge,the same nurse knocked the patient’s back when Before meals 30 min and 2 hours after meals respectively.The average air pressure changes and the occurrence of adverse reactions before and after knocking the back were observed and compared.Result：The author observed and recorded the pressure in airbag before and after knocking the back for 90 times.There were 6 cases with no change of pressure in airbag after knocking the back,accounting for 6.7%,and there were 84 cases that were changed,accounting for 93.3%.The average pressure in airbag after knocking the back was （25±3.6）cm H2O,it was significantly lower than before knocking the back[（28±2.4）cm H2O],the difference was statistically significant（t=4.128,P〈0.01）.The adverse reaction rate after knocking the back was 26.7%, it was significantly lower than before knocking the back（96.7%）,the difference was statistically significant（t=31.093, P〈0.01）.Conclusion：Knock the back should pay attention to monitoring pressure in airbag,adjust the volume of airbag,in order to maintain suitable pressure in airbag and reduce adverse reactions,so as to prevent air leakage and occurrence of aspiration pneumonia.