本文關(guān)鍵詞： 人工氣道 加溫濕化器 密閉式吸痰 氣道管理 濕化　出處：《吉林大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 探討加溫濕化器聯(lián)合密閉式吸痰對人工氣道患者的護(hù)理效果，為形成系統(tǒng)的、科學(xué)的氣道管理規(guī)范提供依據(jù)。 方法： 本研究選取2013年12月-2014年7月吉林大學(xué)第一醫(yī)院神經(jīng)外科ICU102例置入人工氣道的患者，按隨機(jī)方法分為試驗(yàn)組（加溫濕化器聯(lián)合密閉式吸痰組）49例和對照組（人工鼻聯(lián)合一次性吸痰組）53例，兩組患者均接受其它日常常規(guī)護(hù)理，所有操作由神經(jīng)外科ICU接受過統(tǒng)一培訓(xùn)的責(zé)任護(hù)士完成。對兩組患者的痰液黏稠度、濕化效果、痰痂發(fā)生率、肺部感染發(fā)生率、痰細(xì)菌培養(yǎng)陽性率、痰培養(yǎng)陽性菌株次數(shù)、人工氣道留置時(shí)間及ICU住院時(shí)間進(jìn)行比較。全部數(shù)據(jù)采用SPSS17.0軟件和Excel表格進(jìn)行統(tǒng)計(jì)分析，計(jì)量資料采用t檢驗(yàn)，計(jì)數(shù)資料采用χ2檢驗(yàn)，等級(jí)資料采用秩和檢驗(yàn)，P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1.兩組患者痰液黏稠度在第五天（P0.05）和第七天（P0.05）觀察組均比對照組稀薄。 2.兩組平均血氧飽和度在第三天、第五天和第七天比較均無統(tǒng)計(jì)學(xué)差異（P＞0.05）。 3.試驗(yàn)組患者未形成痰痂，有3例（6.1%）患者發(fā)生肺部感染，對照組有7例（13.2%）患者形成痰痂，有12例（22.6%）患者發(fā)生肺部感染，兩組比較，試驗(yàn)組痰痂發(fā)生率（P0.05）和肺部感染發(fā)生率（P0.05）均低于對照組。 4.試驗(yàn)組呼吸道細(xì)菌培養(yǎng)陽性例數(shù)較對照組少，，差別有統(tǒng)計(jì)學(xué)意義（P0.05）;兩組的痰培養(yǎng)菌株種類差別無統(tǒng)計(jì)學(xué)意義（P0.05）。 5.試驗(yàn)組人工氣道留置時(shí)間為（7.51±2.38）d, NSICU住院時(shí)間為（12.49±3.19）d，對照組人工氣道留置時(shí)間為（10.47±3.37）d，NSICU住院時(shí)間為（13.94±2.48）d，兩組比較，試驗(yàn)組人工氣道留置時(shí)間（P 0.05）及NSICU住院時(shí)間（P 0.05）均少于對照組。 結(jié)論： 1.兩種氣道護(hù)理方法中，加溫濕化器聯(lián)合密閉式吸痰法氣道濕化效果更佳，但與人工鼻聯(lián)合一次性吸痰法在維持SPO2穩(wěn)定性方面無明顯差異。 2.加溫濕化器聯(lián)合密閉式吸痰法可以更好地減低痰液粘稠度，具有長期臨床效果。 3.加溫濕化器聯(lián)合密閉式吸痰法可明顯降低肺部感染發(fā)生率，且在研究期間未發(fā)生痰痂，對促進(jìn)患者疾病康復(fù)具有積極影響。 4.加溫濕化器聯(lián)合密閉式吸痰法可以減少呼吸道內(nèi)細(xì)菌的定植。 5．加溫濕化器聯(lián)合密閉式吸痰法產(chǎn)生良好的氣道護(hù)理效果，縮短人工氣道留置時(shí)間和ICU住院時(shí)間，有利于患者及早出院，對促進(jìn)床位周轉(zhuǎn)和提高醫(yī)院的社會(huì)效應(yīng)產(chǎn)生積極影響。
[Abstract]:Objective:. To explore the nursing effect of humidifier combined with closed suction on patients with artificial airway and provide basis for systematic and scientific airway management. Methods:. From December 2013 to July 2014, we selected ICU102 patients who were placed in artificial airway in the first Hospital of Jilin University. According to the random method, the patients were divided into the experimental group (49 cases in the hyperthermia humidifier combined with closed suction group) and the control group (53 cases in the artificial nose combined with one-off aspiration group). The patients in both groups received other routine nursing care. All operations were performed by the nurses responsible for the unified training of ICU in neurosurgery. The sputum viscosity, humidification effect, sputum eschar rate, pulmonary infection rate, sputum bacterial culture positive rate, sputum culture positive strains, sputum culture positive rate, sputum culture positive rate, sputum culture positive rate, sputum culture positive rate, The retention time of artificial airway and the hospitalization time of ICU were compared. All the data were statistically analyzed by SPSS17.0 software and Excel table, the measurement data were analyzed by t test, and the count data were analyzed by 蠂 2 test. Grade data using rank sum test (P 0.05) was statistically significant. Results:. 1. The viscosity of sputum in the two groups was thinner than that in the control group at day 5th (P 0.05) and day 7th (P 0.05). 2. There was no significant difference in the mean oxygen saturation between the two groups on the third day, 5th days and 7th days (P > 0.05). 3. In the test group, sputum scab was not formed, there were 3 patients with sputum infection, 7 patients in the control group developed sputum scab, 12 patients in the control group developed sputum scab, and 12 patients developed pulmonary infection. The incidence of sputum scab and pulmonary infection in the test group was lower than that in the control group. 4. The number of positive cases of respiratory tract bacteria in the test group was less than that in the control group, and the difference was statistically significant (P 0.05), and there was no significant difference between the two groups in sputum culture strains. 5. The retention time of artificial airway and NSICU were 7.51 鹵2.38 and 12.49 鹵3.19 days in the experimental group and 10.47 鹵3.37 days in the control group, respectively. Compared with the control group, the retention time of artificial airway in the trial group was less than that in the control group (P 0.05) and NSICU (P 0.05). Conclusion:. 1. In the two kinds of airway nursing methods, the humidifier combined with closed suction has better effect on airway humidification, but there is no significant difference between the two methods in maintaining the stability of SPO2. 2. The temperature humidifier combined with closed sputum suction can reduce the mucus viscosity of sputum better and has long-term clinical effect. 3. Warming and humidifying apparatus combined with closed sputum suction can significantly reduce the incidence of pulmonary infection, and no sputum scab occurred during the study period, which has a positive effect on promoting the rehabilitation of patients. 4. Warming humidifier combined with closed sputum suction can reduce bacterial colonization in respiratory tract. 5. Warming humidifier combined with closed sputum suction had good effect on airway nursing, shortening the time of artificial airway indwelling and ICU hospitalization, which was beneficial to the early discharge of patients and had a positive effect on promoting bed turnover and improving the social effect of hospital.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R472

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