ESEIA理论下气道管理在重症颅脑损伤合并ARDS患者机械通气中的应用

目的　分析ESEIA理论［清除（eliminate）、简化（simplify）、增加（establish）、整合（integrate）、自动化（automate）］下气道管理在重症颅脑损伤合并急性呼吸窘迫综合征（ARDS）患者机械通气中的应用。方法　本研究为前瞻性研究。选取济南市中心医院2019年10月至2021年10月收治的重症颅脑损伤合并ARDS机械通气患者70例，采用随机数字表法将其均分为对照组和观察组。对照组35例中男19例、女16例，年龄（45.28±2.41）岁；观察组35例中男21例、女14例，年龄（45.11±2.23）岁。对照组实施普通流程化气道管理，观察组在对照组基础上实施基于ESEIA理论的流程优化气道管理。比较两组患者呼吸系统并发症发生率、血气分析指标、痰菌培养阳性率、5 d吸痰次数、机械通气舒适度以及护理满意度。统计学方法采用独立样本t检验、χ²检验。结果　观察组患者的呼吸系统并发症发生率、痰菌培养阳性率均低于对照组［5.71%（2/35）比22.86%（8/35）、2.86%（1/35）比20.00%（7/35）］，差异均有统计学意义（χ²=4.200、5.081，P=0.040、0.024）；干预后，观察组的血氧饱和度（SaO₂）、动脉血氧分压（PaO₂）、5 d吸痰次数均优于对照组［（95.79±1.42）%比（89.57±2.01）%、（87.32±1.01）mmHg比（83.25±2.74）mmHg（1 mmHg=0.133 kPa）、（30.25±4.37）次比（38.11±6.28）次］，差异均有统计学意义（t=14.952、8.245、6.078，均P<0.001）；干预后，观察组的生理、心理精神、社会文化、环境舒适度评分均优于对照组［（18.55±1.11）分比（15.65±1.52）分、（34.22±1.65）分比（29.92±2.33）分、（21.48±1.39）分比（16.77±1.26）分、（25.44±2.41）分比（21.37±2.05）分］，差异均有统计学意义（t=9.115、8.910、14.853、7.610，均P<0.001）；观察组患者的护理满意度高于对照组［97.14%（34/35）比82.86%（29/35）］，差异有统计学意义（χ²=3.968，P=0.046）。结论　ESEIA理论下气道管理可有效降低重症颅脑损伤合并ARDS机械通气患者的呼吸系统并发症发生率，改善血气指标，提升预后，提升患者机械通气期间舒适度，提高护理满意度。

Application of airway management based on ESEIA theory in mechanical ventilation for patients with severe craniocerebral injury combined with ARDS

Objective　To analyze the application of airway management based on ESEIA theory (eliminate – simplify – establish – integrate - automate) in mechanical ventilation for patients with severe craniocerebral injury combined with acute respiratory distress syndrome (ARDS). Methods　It was a prospective study. A total of 70 patients with severe craniocerebral injury combined with ARDS treated by mechanical ventilation in Jinan Central Hospital from October 2019 to October 2021 were selected, and were divided into a control group and an observation group by the random number table method. In the control group, there were 19 males and 16 females, aged (45.28±2.41) years; in the observation group, there were 21 males and 14 females, aged (45.11±2.23) years. The control group was given routine airway management, and the observation group was given ESEIA theory-based flow-optimized airway management on the basis of the control group. The incidence of respiratory complications, blood gas analysis indexes, positive rate of sputum culture, 5-day sputum suction times, mechanical ventilation comfort, and nursing satisfaction were compared between the two groups. Independent sample t test and χ² test were used. Results　The incidence of respiratory complications and positive rate of sputum culture in the observation group were lower than those in the control group 5.71% (2/35) vs. 22.86% (8/35), 2.86% (1/35) vs. 20.00% (7/35)], with statistically significant differences (χ²=4.200 and 5.081; P=0.040 and 0.024). After intervention, the blood oxygen saturation (SaO₂), arterial partial pressure of oxygen (PaO₂), and 5-day sputum suction times in the observation group were all better than those in the control group (95.79±1.42)% vs. (89.57±2.01)%, (87.32±1.01) mmHg vs. (83.25±2.74) mmHg(1 mmHg=0.133 kPa), (30.25±4.37) times vs. (38.11±6.28) times], with statistically significant differences (t=14.952, 8.245, and 6.078; all P<0.001). After intervention, the physical, psychological, social and cultural, and comfort scores in the observation group were better than those in the control group (18.55±1.11) points vs. (15.65±1.52) points, (34.22±1.65) points vs. (29.92±2.33) points, (21.48±1.39) points vs. (16.77±1.26) points, (25.44±2.41) points vs. (21.37±2.05) points], with statistically significant differences (t=9.115, 8.910, 14.853, and 7.610; all P<0.001). The nursing satisfaction of the observation group was higher than that of the control group 97.14% (34/35) vs. 82.86% (29/35)], with a statistically significant difference (χ²=3.968, P=0.046). Conclusion　Airway management based on ESEIA theory can effectively reduce the incidence of respiratory complications in patients with severe craniocerebral injury combined with ARDS treated by mechanical ventilation, and improve their blood gas indicators, prognosis, comfort during mechanical ventilation, and nursing satisfaction.