人工鼻在颈髓损伤气管切开患者气道管理中应用.docVIP

人工鼻在颈髓损伤气管切开患者气道管理中应用摘 要 目的：探讨人工鼻在颈髓损伤气管切开患者气道管理中的应用效果。方法：将42例呼吸道未感染颈髓损伤气管切开患者随机分为实验1组和对照1组各21例，将48例呼吸道感染颈髓损伤气管切开患者随机分为实验2组和对照2组各24例，实验组采用人工鼻湿化法，对照组采用微量注射泵湿化法。结果：实验1组与对照1组、实验2组与对照2组痰液培养结果和气道湿化效果比较差异有统计学意义(P＜0.05)。结论：人工鼻有良好的气道湿化效果，能有效预防和控制颈髓损伤气管切开患者的肺部感染，避免交叉感染。 关键词 颈髓损伤；气管切开；人工鼻；肺部感染 中图分类号：R473.6 文献标识码：A 文章编号：1006-7256（2011)15-0006-03 Application of artificial nose to airway management of patients with cervical spinal cord injury after tracheotomy Li Li-li, Ye Mao (The First Hospital of China Medical University, Shenyang Liaoning 110001, China) Abstract Objective: To explore the application effect of artificial nose to airway management of patients with cervical spinal cord injury after tracheotomy. Methods: 42 non respiratory tract infection patients with spinal cord injury after tracheotomy were randomly divided into experimental group A and control group A (21 cases for each group), and the other 48 respiratory tract infection patients with cervical spinal cord injury after tracheotomy were randomly divided into experimental group B and control group B (24 cases for each group). The airway humidification via artificial nose was applied in the experimental group and the airway humidification by micro-injection pump was used in the control group. Results: There were statistically significant differences in the comparison of sputum culture results and the effect of airway humidification between the experimental group A and the control group A and between the experimental group B and the control group B (P 1.3 观察项目 实验1组在使用后3 d、5 d、7 d分别做痰液培养以及各种相关指标的测定,如刺激性咳嗽、吸氧效果(持续生命体征监测值在正常范围内且SpO?290%为有效,反之为缺氧)等。留痰前,先用碘伏消毒人工气道外口,并消毒内口2 cm(注意消毒液不可滴入气管) ,再用无菌留痰装置吸取痰液。操作时要注意采取严格的无菌技术,痰液及时送细菌培养与药敏试验,对照1 组也同期做好痰液培养和各指标的测定。观察实验2组和对照2组患者的刺激性咳嗽、痰液黏稠度、痰阻次数、痰菌转阴率（第5天采集）及吸氧效果等。痰液黏稠度判断标准［4］：Ⅰ度：痰液如米汤样或泡沫样,患者能轻易咳出;Ⅱ度：痰液较黏稠,吸痰后有少量痰液滞留在玻璃管内壁,易被水冲洗干净,患者能自行咳出;Ⅲ度：痰液外观呈黄色,明显黏稠,吸痰后玻璃接头内壁上滞留大量痰液,不易被水冲洗干净,患者排痰困难或出现痰痂。 1.4 统计学方法 采用SPSS13.0软件进行统计学处理，数据采用χ2检验， P