人工气道患者痰痂堵管的发生率及其影响因素的研究

目的：探讨因不同病因建立人工气道患者痰痂堵管的发生率及可能的影响因素。方法：选择2011-01-01-2011-12-31收入我院急诊抢救室、急诊监护室（EICU）的427例因各种原因建立人工气道治疗24h以上的患者,在给予临床标准的气道护理和原发病治疗的情况下,分别记录不同病因患者痰痂堵管的发生率及可能的影响因素。结果：427例患者中69例发生了痰痂堵管,发生率约为16.2%,气管插管患者中为15.3%,气管切开患者为22.2%,两者间比较差异无统计学意义。不同病种中重型颅脑损伤发生痰痂堵管的概率最高为20.4%。患者有肺部感染、带管时间长、咳嗽反射消失、痰液粘稠时形成痰痂堵管的可能性较大。结论：即使经过充分的预防及护理,痰痂堵管仍是临床常见的人工气道并发症之一。尤其是对于重型颅脑损伤、带管时间长、痰液粘稠、有肺部感染的患者,更需密切注意。同时,新的预防痰痂堵管的方法也是临床所需。

The incidence and impact factors of sputum crust obstruction in connula of patients with artificial airway

Objective：To investigate the incidence rate and possible inHuencing lactors of sputum crust obstruction in cannula of patients with artificial airway. Method：Summarized 427 patients with different critical illness who were treated in our emergency rescue room or Emergency Intensive Care Unit （EICU） from January 1,2011 to December 31,2011 ,and were established artificial airway by tracheal intubation or tracheotomy more than 24 hours. Recorded occurrence and possible influencing factors of sputum crust obstruction in cannula when all patients were given clinical criteria care for ventilated patients, such as wetting and heating of artificial airway, sputum suction and dilution, turning shot sputum and exhaustive treatment for their primary disease. Result：Sputum crust obstruc- tion in cannula occurred in 69 patients, the incidence rate was 16.2 %. It was highest in patients with severe trau- matic brain injury, reaching 20.40/~. Sputum crust obstruction in cannula was more likely to happen to patients with lung infection, sticky sputum,long intubated time and no cough reflex. Conclusion：Even after the adequate prevention and care, sputum crust obstruction in cannu[a is still a common clinical complication of artificial airway. Especially in patients with gravis type craniocerebral injury, lung infection, sticky sputum, long intubated time and no cough reflex,who need to get close attention. At the same time,new method to prevention sputum crust obstruction in cannula is clinically required.