ICU患者经口气管插管拔管后发生获得性吞咽障碍的危险因素及护理对策

目的探讨ICU患者经口气管插管拔管后发生获得性吞咽障碍(ASD)的危险因素及护理对策。方法选取2015年1月至2019年12月在医院重症医学科行经口气管插管并成功拔管的180例患者作为研究对象,分析发生ICU-ASD的危险因素性别、年龄、体质量指数(BMI)、吸烟史、血糖、血压、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、插管时间、是否二次插管],并将单因素分析差异有统计学意义的资料纳入多因素Logistic回归模型进行分析。结果180例患者,72例(40.0%)发生ICUASD;年龄>50岁(OR=2.358,95%CI 2.022~4.734)、APACHEⅡ评分高(OR=1.298,95%CI 1.187~2.351)、插管时间长(OR=1.061,95%CI 1.053~1.136)是发生ICU-ASD的独立危险因素。结论ICU-ASD发生率较高,年龄>50岁、APACHEⅡ评分高、插管时间较长是其发生的独立危险因素,医护人员对有此类特征的患者应提前进行临床干预,拔管后应尽早行吞咽功能评估或康复。

Risk Factors and Nursing Strategies of the Occurrences of Acquired Swallowing Disorders after ICU Patients Treated with Oral Tracheal Intubation and Extubation

Objective The risk factors and nursing strategies of the occurrences of acquired swallowing disorders(ASD)after ICU patients treated with oral tracheal intubation and extubation were explored.Methods 180 patients who underwent endotracheal intubation and successful extubation in the department of ICU in the hospital from January 2015 to December 2019 were selected as the subjects in this study.The risk factors of the occurrences of ICU-ASD were analyzed,including gender,age,body mass index(BMI),smoking history,blood glucose,blood pressure,acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,intubation time,and whether the patients were treated with second intubation or not.According to the results of the single-factor analysis,the factors with statistical significance were included in the multi-factor Logistic regression model for further analysis.Results Among all the 180 patients,there were 72 cases occurred with ICUASD,and the proportion was was 40.0%.Multivariate Logistic regression analysis showed that age>50 years old(OR=2.358,95%CI 2.022~4.734),high APACHEⅡscores(OR=1.298,95%CI 1.187~2.351),long intubation time(OR=1.061,95%CI 1.053~1.136)were the independent risk factors for ICU-ASD.Conclusions The incidence of ICU-ASD was relatively high and age>50 years old,high APACHEⅡscores and long intubation time were the independent risk factors for ICU-ASD.It suggested that medical staff should carry out clinical intervention in advance for ICU-ASD patients with such characteristics,and carry out swallowing function evaluation or rehabilitation as early as possible after extubation.