本文關(guān)鍵詞：機械通氣患者持續(xù)氣囊壓力監(jiān)測的臨床研究　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 人工氣道 氣囊壓力 持續(xù)測壓法 臨床活動 時間

【摘要】：目的:建立人工氣道行機械通氣是救治危重患者生命的重要措施,氣囊管理則是人工氣道管理的重要內(nèi)容。合理有效的氣囊管理對防止機械通氣時氣道漏氣,保證有效通氣量;避免口腔分泌物、胃內(nèi)容物誤入氣道引發(fā)呼吸機相關(guān)性肺炎;防止氣道粘膜損傷都有非常重要的意義。本次研究通過體外實驗與臨床研究相結(jié)合的方法,體外實驗部分應(yīng)用壓力傳感器與氣囊測壓表同時測量氣囊壓力,以判斷壓力傳感器監(jiān)測氣囊壓力值的準確性;在臨床應(yīng)用壓力傳感器持續(xù)監(jiān)測過程中分析吸痰、翻身、口腔護理及吞咽對氣囊壓力的影響,觀察氣囊壓力隨時間的變化規(guī)律,探討該持續(xù)監(jiān)測方法的臨床可行性,是否值得臨床推廣。方法:1體外實驗部分通過三通分別連接壓力傳感器及氣囊測壓表,兩種測壓方法同時測量不同體積及不同型號氣囊的壓力,并對測壓值進行比較。2臨床實驗部分通過壓力傳感器和三通及一個30cm長的延長管與氣管導(dǎo)管外露氣囊相連,壓力傳感器與PHILIPS床旁監(jiān)護儀相連,通過監(jiān)護儀持續(xù)監(jiān)測氣囊壓力。進行氣囊壓力校正時要求患者取半臥位,床頭抬高30度,頭部為正中位,氣囊充氣至25cm H20,應(yīng)用聽診器聽診,確定無氣道漏氣。監(jiān)護儀報警設(shè)置為低限20cm H20,高限30cm H20。持續(xù)監(jiān)測數(shù)據(jù)每隔30分鐘記錄一次。臨床活動包括吸痰、翻身及口腔護理,要求記錄活動前、活動時、活動后5分鐘、活動后15分鐘、活動后30分鐘的氣囊壓力;另外,記錄吞咽前、吞咽時、吞咽后1分鐘、吞咽后5分鐘、吞咽后10分鐘的氣囊壓力。結(jié)果:1體外實驗證實壓力傳感器測量值與氣囊測壓表的測量值經(jīng)配對t檢驗分析差異無統(tǒng)計學(xué)意義,t=0.781,P=0.449。2吸痰時氣囊壓高于吸痰前氣囊壓,差異有統(tǒng)計學(xué)意義,吸痰時氣囊壓為39.28±15.14cm H20,已超過30cm H20;吸痰后5分鐘氣囊壓略高于吸痰前氣囊壓,差異有統(tǒng)計學(xué)意義;吸痰后15分鐘、吸痰后30分鐘與吸痰前氣囊壓力值差異無統(tǒng)計學(xué)意義。3翻身前與翻身時氣囊壓力值差異有統(tǒng)計學(xué)意義(P0.05),翻身時氣囊壓力高于翻身前氣囊壓力值;翻身前與翻身后5分鐘氣囊壓力值差異有統(tǒng)計學(xué)意義,翻身后5分鐘氣囊壓力略高于翻身前氣囊壓力值,但翻身后5分鐘氣囊壓力并未超過30cm H2O;翻身前與翻身后15分鐘、翻身后30分鐘氣囊壓力值差異無統(tǒng)計學(xué)意義。4口腔護理前與口腔護理時氣囊壓力值差異有統(tǒng)計學(xué)意義(P0.05),口腔護理時氣囊壓力高于口腔護理前氣囊壓力值;口腔護理前與口腔護理后5分鐘、15分鐘、30分鐘氣囊壓力值差異無統(tǒng)計學(xué)意義。5吞咽前與吞咽時氣囊壓力值差異有統(tǒng)計學(xué)意義(P0.05),吞咽時氣囊壓力高于吞咽前氣囊壓力值;吞咽前與吞咽后1分鐘、5分鐘、10分鐘氣囊壓力值差異無統(tǒng)計學(xué)意義。6持續(xù)監(jiān)測數(shù)據(jù)中不同時間點的氣囊壓采用重復(fù)測量的方差分析,F=8.367,P=0.001,各時間點的氣囊壓力值存在統(tǒng)計學(xué)差異,即至少有兩個時間點間存在差異。從各時間點氣囊壓力值進行兩兩比較結(jié)果及氣囊壓力均值繪制圖可以看出,氣囊壓會隨著時間的推移逐漸下降。結(jié)論:1應(yīng)用壓力傳感器可以準確監(jiān)測氣囊壓。2臨床活動會導(dǎo)致氣囊壓出現(xiàn)短暫性升高,瞬時壓力增高會誤導(dǎo)工作人員對氣囊壓力值安全性的判斷,不可盲目抽氣降低氣囊壓以免增加漏氣和誤吸的風(fēng)險。3氣囊存在微漏氣,氣囊壓會隨著時間的推移逐漸下降,建議每8h校正一次氣囊壓,為氣囊補氣。4使用壓力傳感器能持續(xù)動態(tài)監(jiān)測氣囊壓,保證氣囊壓處于控制范圍,值得臨床推廣。
[Abstract]:Objective: to establish artificial airway and mechanical ventilation is an important measure for the treatment of critically ill patients life, balloon management is an important content of management of artificial airway gasbag management. Reasonable and effective to prevent mechanical ventilation airway leakage, ensure effective ventilation; avoid oral secretions, stomach contents into the airway causing ventilator-associated pneumonia; prevention is very the important significance of airway mucosal injury. Methods this study combined with clinical study of in vitro experiments, in vitro experiments of pressure sensor and airbag pressure gauge measurement at the same time balloon pressure, to determine the accuracy of monitoring air pressure value of the pressure sensor; suction, turning analysis in clinical application process of continuous monitoring of pressure sensor, influence oral nursing and swallowing of air pressure and air pressure were changing with time, to explore the continuous monitoring method of Pro The bed is feasible, whether it is worthy of clinical promotion. Methods: 1 in vitro through three links are respectively connected with the pressure sensor and the air pressure gauge, simultaneous measurement of different size and different types of air pressure of two kinds of measuring method for pressure, and compare the value of.2 part of clinical trials and three pass through a pressure sensor and a 30cm long prolonged tracheal catheter is connected with the exposed tube, pressure sensor and PHILIPS bedside monitor is connected, through continuous monitoring of air pressure monitor. The air pressure correction when patients were asked to take a semi recumbent, head elevation of 30 degrees, the head to the middle, inflated to 25cm H20, the application of stethoscope auscultation, no airway leak. Monitor the alarm is set to low limit high limit 30cm 20cm H20, H20. continuous monitoring data recorded every 30 minutes. The clinical activities include suctioning, turning and oral care requirements recorded before the event, live When, 5 minutes after the event, 15 minutes after the event, the air pressure 30 minutes of activity; in addition, the record before swallowing, swallowing, swallowing after 1 minutes, 5 minutes after swallowing, the air pressure 10 minutes after swallowing. Results: 1 in vitro experiments confirmed that the pressure sensor measurements by paired t test analysis of differences no statistical significance, t=0.781 and air pressure gauge measurement value of P=0.449.2 when the pressure is higher than air suction suction before air pressure, the difference was statistically significant, when the suction air bag pressure was 39.28 + 15.14cm H20, 30cm has more than H20; 5 minutes after suctioning air pressure slightly higher than before the suction air bag pressure, have statistically significant differences; 15 minutes after suctioning, 30 minutes after suctioning and suction before the air pressure value was no significant difference between.3 and turning the air pressure before turning over the value of the difference was statistically significant (P0.05), turning the air pressure is higher than the gas pressure value before turning capsule; before turning and turning 5 minutes after the air pressure difference has statistical significance, over 5 minutes after the air pressure is slightly higher than that of turning the front airbag pressure value, but turn over 5 minutes after the air pressure does not exceed 30cm H2O; turn over before and after turning over 15 minutes, 30 minutes after turning the air pressure value had no significant difference between.4 and oral care before and oral care when the air pressure difference was statistically significant (P0.05), when air pressure is higher than the oral care oral care before the air pressure value; oral care oral care before and after 5 minutes, 15 minutes, 30 minutes of air pressure had no significant difference between the.5 and the swallow before swallowing air pressure value were statistically significant (P0.05) when the air pressure is higher than that of swallowing before swallowing air pressure value; before swallowing and swallowing after 1 minutes, 5 minutes, 10 minutes of air pressure value of the difference was not statistically significant.6 balloon continuous monitoring data at different time point pressure Using repeated measures analysis of variance, F=8.367, P=0.001, there was a significant difference between the values of air pressure at each time point, that there exist at least two time points. The difference between the result and the comparison of mean air pressure drawing 22 from each time point of the air pressure value can be seen, the air bag pressure will gradually decreased with time. Conclusion: 1 the application of pressure sensor can accurately monitor the air pressure.2 clinical activity can lead to air bag pressure transient increase, the instantaneous pressure increased to mislead the staff safety value judgment on the air pressure, not blindly pumping gas to reduce the risk of.3 balloon cuff pressure to avoid increasing the leakage and aspiration of the existence of micro leakage, air pressure gradually decreased over time, every school is 8h times for.4 air balloon balloon pressure, a pressure sensor using continuous dynamic monitoring can ensure air pressure in the air bag pressure, control range, It is worthy of clinical promotion.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R472

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