口咽分泌物微误吸管理方案在ICU气管插管患者中的应用研究

doi:10.3761/j.issn.0254-1769.2024.10.001

摘要/Abstract

摘要：

目的构建ICU气管插管患者口咽分泌物微误吸管理方案并进行临床应用。方法基于证据总结和专家函询，构建ICU气管插管患者口咽分泌物微误吸管理方案，该方案包含微误吸危险因素识别、体位管理、导管及气囊选择、气囊管理、机械通气与镇痛镇静管理、口腔及气囊上分泌物清除、口腔护理7个方面、19条内容。便利选取2022年6月—2023年9月在苏州市某三级甲等医院综合ICU接受治疗的141例气管插管患者为研究对象。根据病区将患者分为试验组（n=72）和对照组（n=69），试验组应用ICU气管插管患者口咽分泌物微误吸管理方案，对照组采用呼吸机相关性肺炎（ventilator associated pneumonia，VAP）集束化护理措施。比较两组微误吸、VAP发生率和微误吸发生时间，以及机械通气时长、ICU住院时长和疾病转归。结果干预后两组口咽分泌物微误吸发生率和发生时间及机械通气时长的比较，差异有统计学意义（P<0.05）。两组VAP发生率、ICU住院时长和疾病转归的比较，差异无统计学意义（P>0.05）。试验组与对照组VAP的平均发生时间分别为气管插管后7.5 d和3.8 d。结论 ICU气管插管患者口咽分泌物微误吸管理方案的实施有利于降低微误吸发生率，推迟微误吸和VAP发生时间，缩短机械通气时长。

关键词: 重症监护病房, 插管法，气管内, 口咽分泌物, 微误吸, 护理

Abstract:

Objective To construct and apply a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients. Methods Based on evidence summaries and expert consultation，a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients was constructed，consisting of 19 items covering 7 aspects including identification of risk factors，position management，tube and cuff selection，cuff management，mechanical ventilation management，pain and sedation management，removal of oropharyngeal and subglottic secretions，and oral care. Convenience sampling was used to select 141 ICU intubated patients from a tertiary A comprehensive hospital in Suzhou from June，2022 to September，2023. Patients were divided into an experimental group（n=72） and a control group（n=69） according to the wards. The experimental group received the management plan for microaspiration of oropharyngeal secretions in ICU intubated patients. The control group received the nursing bundle for ventilator associated pneumonia（VAP）. The incidence and time from intubation to microaspiration and VAP，duration of mechanical ventilation，ICU length of stay，and disease outcome were compared between the 2 groups. Results The incidence of microaspiration of oropharyngeal secretions，the duration of mechanical ventilation，time from intubation to microaspiration showed significant differences between the 2 groups（P<0.05）. There were no significant differences in the incidence of ventilator associated pneumonia，ICU length of stay，and disease outcome between the 2 groups（P>0.05）. The time from intubation to VAP in the experimental group was 7.5 days, and that in the control group was 3.8 days. Conclusion The application of the management plan for microaspiration of oropharyngeal secretions in ICU intubated patients is beneficial for reducing the incidence of microaspiration，delaying the time from intubation to microaspiration and VAP，and shortening the duration of mechanical ventilation.

Key words: Intensive Care Units, Intubation，Intratracheal, Oropharyngeal Secretions, Microaspiration, Nursing Care

邓伟, 李小珍, 王英, 谭丽萍, 周保纯, 田凤美, 黄慧, 邹洁, 唐雯, 徐苏娟. 口咽分泌物微误吸管理方案在ICU气管插管患者中的应用研究[J]. 中华护理杂志, 2024, 59(10): 1157-1163.

DENG Wei, LI Xiaozhen, WANG Ying, TAN Liping, ZHOU Baochun, TIAN Fengmei, HUANG Hui, ZOU Jie, TANG Wen, XU Sujuan. Application of a management plan for microaspiration of oropharyngeal secretions in ICU patients with tracheal intubation[J]. Chinese Journal of Nursing, 2024, 59(10): 1157-1163.

图/表 4

表1 ICU气管插管患者口咽分泌物微误吸管理方案

Table 1 Management plan for microaspiration of oropharyngeal secretions in ICU patients with tracheal intubation

表2 两组一般资料比较

Table 2 Comparisons of generall data between the 2 groups

表3 两组微误吸发生率、呼吸机相关性肺炎发生率、疾病转归、微误吸发生时间比较[例（百分比，%）]

Table 3 Comparison of the incidence of microaspiration and VAP，the outcome of the disease，the time from intubation to microaspiration between the 2 groups[cases（percentage，%）]

表4 两组ICU住院时长及机械通气时长比较

Table 4 Comparison of the，length of ICU stay and duration of mechanical ventilation between the 2 groups

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