肺叶体表投影定位结合肺段引流排痰技术对吸入性肺炎患者气道廓清的效果研究

doi:10.3761/j.issn.0254-1769.2025.09.005

摘要/Abstract

摘要：

目的探讨采用肺叶体表投影定位结合肺段引流排痰技术对吸入性肺炎患者气道廓清效果的影响，旨在为临床护理实践提供参考。方法采用便利抽样法，选取2022年5月—2024年10月北京市某三级甲等医院收治的62例颅脑疾病围手术期并发吸入性肺炎患者为研究对象，将2023年8月—2024年10月收治的31例患者作为试验组，将2022年5月—2023年7月收治的31例患者作为对照组，试验组在常规机械扣背排痰气道廓清技术的基础上实施肺叶体表投影定位结合肺段引流排痰技术，对照组实施常规机械扣背排痰气道廓清技术。干预后，比较两组氧合状态、炎性指标、治疗有效率、生命体征、吸咳痰次数的差异。结果干预后，试验组氧合指数、吸咳痰次数、白细胞计数、中性粒细胞百分比、降钙素原水平、白介素-6水平及治疗有效率均优于对照组（P<0.05），两组心率、呼吸频率、C反应蛋白比较，差异无统计学意义（P>0.05）。结论肺叶体表投影定位结合肺段引流排痰技术可有效促进吸入性肺炎患者肺部痰液松动，提高气道廓清效率及肺通气换气能力，改善氧合状态，降低全身炎症水平。

关键词: 吸入性肺炎, 气道廓清技术, 体位引流, 胸部叩拍与振动, 后组颅神经麻痹, 护理

Abstract:

Objective To investigate the effect of lung lobe surface projection localization combined with lung segment drainage sputum technique on airway clearance in patients with aspiration pneumonia，providing a reference for clinical nursing practice. Methods A convenience sampling method was used to select 62 patients with perioperative aspiration pneumonia secondary to brain diseases admitted to a tertiary A hospital in Beijing from May 2022 to October 2024 as the research subjects. A total of 31 patients admitted from August 2023 to October 2024 were assigned to a control group，and 31 patients admitted from May 2022 to July 2023 were assigned to an experimental group. The experimental group received lung lobe surface projection positioning combined with lung segment drainage sputum technique on top of conventional back percussion sputum clearance technique，while the control group received conventional back percussion sputum clearance technique. After the intervention，the differences in oxygenation state，inflammatory test indicators，treatment efficiency，vital signs and frequency of suction coughing between 2 groups were compared. Results After the intervention，the experimental group showed better oxygenation index，frequency of suction coughing，white blood cell count，percentage of neutrophils，procalcitonin levels，interleukin-6 levels，and treatment efficiency compared to those in the control group（P<0.05）. There was no statistically significant difference in heart rate，respiratory rate，and C-reactive protein levels between 2 groups（P>0.05）. Conclusion Lung lobe surface projection positioning combined can effectively promote the patients with aspiration pneumonia of loosening of sputum in the lungs，improve airway clearance efficiency，enhance the patient’s pulmonary ventilation and gas exchange capacity，improve oxygenation levels，and reduce systemic inflammatory levels.

Key words: Aspiration Pneumonia, Airway Clearance Techniques, Postural Drainage, Chest Percussion and Vibration, Lower Cranial Nerve Palsies, Nursing Care

陈丽鸥, 张文婷, 刘俊其, 王允琮, 王振霖, 齐赛, 杨娜. 肺叶体表投影定位结合肺段引流排痰技术对吸入性肺炎患者气道廓清的效果研究[J]. 中华护理杂志, 2025, 60(9): 1056-1061.

CHEN Liou, ZHANG Wenting, LIU Junqi, WANG Yuncong, WANG Zhenlin, QI Sai, YANG Na. Study on the effect of pulmonary lobes surface projection localization combined with pulmonary segment drainage and sputum expectoration technique on airway clearance in patients with aspiration pneumonia[J]. Chinese Journal of Nursing, 2025, 60(9): 1056-1061.

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参考文献 19

[1]	杨云梅. 老年吸入性肺炎的诊断与处理[J/OL]. 中华危重症医学杂志(电子版), 2010, 3(3):150-158.
	Yang YM. Diagnosis and treatment on the elderly with aspiration pneumonia[J/OL]. Chin J Crit Care Med(Electron Ed), 2010, 3(3):150-158.
[2]	Nonaka S, Fujii S, Hara M, et al. Incidence of aspiration pneumonia during hospitalization in Japanese hospitalized cases did not increase whereas concern factors were exacerbated in a time-dependent manner:analysis of Diagnosis Procedure Com-bination(DPC) data[J]. J Clin Biochem Nutr, 2018, 63(1):66-69.
[3]	Yoon HY, Shim SS, Kim SJ, et al. Long-term mortality and prognostic factors in aspiration pneumonia[J]. J Am Med Dir Assoc, 2019, 20(9):1098-1104.e4.
[4]	Or M, Buchanan IA, Sizdahkhani S, et al. Chronic aspiration pneumonitis caused by spontaneous cerebrospinal fluid fistulae of the skull base[J]. Laryngoscope, 2021, 131(3):462-466.
[5]	陈丽鸥, 刘俊其, 王振霖, 等. 1例脊索瘤放疗后颅底骨坏死患者的护理[J]. 中华护理杂志, 2023, 58(15):1864-1868. DOI
	Chen LO, Liu JQ, Wang ZL, et al. Nursing care of a patient with skull base osteonecrosis after radiotherapy for chordoma[J]. Chin J Nurs, 2023, 58(15):1864-1868. DOI
[6]	霍建珊, 张德葵, 沈利平, 等. 16例鼻咽癌放射治疗后进食困难患者的康复护理[J]. 中华护理杂志, 2012, 47(7):616-618.
	Huo JS, Zhang DK, Shen LP, et al. Rehabilitation nursing of 16 patients with eating difficulties after nasopharyngeal carcinoma radiotherapy[J]. Chin J Nurs, 2012, 47(7):616-618.
[7]	刘诗丹, 陈启波, 李荣祝, 等. 鼻咽癌患者放疗后吞咽障碍的发生与治疗研究进展[J]. 中华物理医学与康复杂志, 2018, 40(3):234-236.
	Liu SD, Chen QB, Li RZ, et al. Research progress on the occurrence and treatment of dysphagia after radiotherapy in patients with nasopharyngeal carcinoma[J]. Chin J Phys Med Rehabil, 2018, 40(3):234-236.
[8]	中华医学会呼吸病学分会, 中国老年保健医学研究会呼吸病学分会, 中国呼吸医师分会呼吸职业发展委员会呼吸治疗师工作组, 等. 机械气道廓清技术临床应用专家共识[J]. 中华结核和呼吸杂志, 2023, 46(9):866-879.
	The Chinese Thoracic Society, Chinese Geriatrics Society Respiratory Diseases Branch, Chinese Respiratory Physicians Association Respiratory Career Development Committee Respiratory Therapist Working Group, Chinese Rehabilitation Medicine Association Respiratory Rehabilitation Committee, et al. Expert consensus on clinical application of mechanical airway clearance techniques[J]. Chin J Tuberc Respir Dis, 2023, 46(9):866-879.
[9]	典慧娟, 范艳竹, 王琳琳, 等. 体位及头高位对重型颅脑损伤病人颅内压和脑灌注压的影响[J]. 护理研究, 2020, 34(14):2520-2523.
	Dian HJ, Fan YZ, Wang LL, et al. Effects of body position and head up tilt on intracranial pressure and cerebral perfusion pressure in patients with severe brain injury[J]. Chin Nurs Res, 2020, 34(14):2520-2523.
[10]	Zhao AN, Zeng HR, Yin H, et al. The application of two drainage angles in neurocritical care patients with complicated pneumonia:a randomized controlled trial[J]. PeerJ, 2024,12:e16997.
[11]	Strickland SL, Rubin BK, Drescher GS, et al. AARC clinical practice guideline:effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients[J]. Respir Care, 2013, 58(12):2187-2193. DOI PMID
[12]	陈畏兵, 马红梅. G5体外振动排痰仪辅助老年慢性阻塞性肺疾病合并肺部感染患者排痰的最佳单次治疗时间[J]. 中国医药导报, 2016, 13(5):137-140.
	Chen WB, Ma HM. The best single treatment time of G5 external vibration sputum elimination instrument for sputum elimination of elderly patients combined with COPD and pulmonary infection[J]. China Med Her, 2016, 13(5):137-140.
[13]	杨俊, 谭蕾, 李娜. 体外振动排痰仪辅助急性加重期COPD患者排痰单次使用时间探讨[J]. 护理学杂志, 2015, 30(7):51-52.
	Yang J, Tan L, Li N. Duration of a single use of the vibration sputum-discharging device in patients with acute exacerbated COPD[J]. J Nurs Sci, 2015, 30(7):51-52.
[14]	余卫平. 多层螺旋CT后处理技术对老年吸入性肺炎的影像诊断分析[J]. 中外医疗, 2018, 37(30):156-158.
	Yu WP. Imaging diagnosis of elderly patients with aspiration pneumonia by multislice spiral CT post-processing technique[J]. China Foreign Med Treat, 2018, 37(30):156-158.
[15]	佘君, 丁建文, 申捷, 等. 成人吸入性肺炎诊断和治疗专家建议[J]. 国际呼吸杂志, 2022(2):86-96.
	She J, Ding JW, Shen J, et al. Expert task force on diagnosis and treatment of aspiration pneumonia in adults[J]. Int J Respir, 2022(2):86-96.
[16]	柏树令, 应大君, 丁文龙, 等. 系统解剖学[M]. 8版. 北京: 人民卫生出版社, 2023.
	Bai SL, Ying DJ, Ding WL, et al. Systematic anatomy[M]. 8th ed. Beijing: People’s Medical Publishing House, 2023.
[17]	倪秀梅, 徐凤玲, 陈浩, 等. 基于肺部超声的气道廓清方案在ICU机械通气患者中的应用[J]. 中华护理杂志, 2023, 58(9):1076-1081. DOI
	Ni XM, Xu FL, Chen H, et al. Application of airway clearance program based on lung ultrasound in patients with mechanical ventilation in ICU[J]. Chin J Nurs, 2023, 58(9):1076-1081. DOI
[18]	中国医药教育协会感染疾病专业委员会. 感染相关生物标志物临床意义解读专家共识[J]. 中华结核和呼吸杂志, 2017, 40(4):243-257.
	Chinese Medical Education Association, Infectious Diseases Professional Committee. Expert consensus on the clinical significance of infection-related biomarkers[J]. Chin J Tuberc Respir Dis, 2017, 40(4):243-257.
[19]	孙文丽. 老年吸入性肺炎患者动态监测血清超敏C反应蛋白的临床意义[J/OL]. 中华危重症医学杂志(电子版), 2010, 3(3):170-174.
	Sun WL. Clinical value of high-sensitivity C-reactive protein in the treatment of the elderly with aspiration pneumonia[J/OL]. Chin J Crit Care Med(Electron Ed), 2010, 3(3):170-174.