Establishment and clinical evaluation of artificial airway strategy in neurological coma patients

doi:10.3761/j.issn.0254-1769.2019.06.007

Abstract

Abstract:

Objective To explore the effects of application of artificial airway strategy in neurological coma patients.Methods The clinical data of 283 neurological patients(Glasgow Coma Scale,GCS<6) with artificial airway were collected. Totally 161 patients admitted from 2013 to 2015 were selected as the control group and received routine airway management. The comprehensive artificial airway strategy was performed in 122 patients who were selected as the experimental group hospitalized from 2016 to 2018. The characteristics of sputum and subglottic secretion,incidence of pulmonary infection,length of stay in neurosurgical intensive care unit and average duration of hospitalization were analyzed before and after intervention.Results For the experimental group,the volume of sputum and subglottic secretion were significantly decreased(P<0.001). Compared with the control group,the pulmonary infection rate was remarkably decreased to 32.8% (P<0.01). Length of stay in neurosurgical intensive care unit and average duration of hospitalization were reduced in the experimental group than the control group (P<0.01 and P<0.001). The score for evaluation of the performance efficiency of comprehensive airway management was 94.6±1.8.Conclusion Application of comprehensive airway management in coma patients can improve the characteristics of sputum,reduce the pulmonary infection rate,shorten duration of hospitalization,and improve the prognosis.

Key words: Critical Illness, Intensive Care Units, Tracheotomy, Airway Management

摘要：

目的探讨神经外科重症昏迷患者人工气道管理方案的临床应用效果。方法制订神经外科昏迷患者人工气道管理方案,包括综合评估、系统实施、量表督查和落实改进4个方面。收集我院神经重症监护单元收治的283例格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)<6分且建立气管切开人工气道的神经重症昏迷患者的临床资料。其中2013年—2015年的161例患者为对照组,采取常规气道管理模式;2016年—2018年的122例患者为试验组,实施神经外科昏迷患者人工气道管理方案,分别收集两组干预前和干预1周后痰液性状、声门下吸引物性状、肺部感染发生率、ICU住院时间和平均住院日的资料。结果试验组痰液和声门下吸引物显著减少,性状较对照组明显改善(P<0.001);试验组肺部感染发生率为32.8%,较对照组显著下降(P<0.01);试验组ICU住院时间和平均住院日均显著降低(P<0.01和P<0.001)。人工气道工作小组气道综合管理措施执行效果量化评分为(94.6±1.8)分。结论落实神经外科昏迷患者人工气道管理方案,能够改善患者的痰液性状,降低肺部感染发生率,缩短住院日,改善患者预后。

关键词: 危重病, 重症监护病房, 气管切开术, 气道管理

HU Na, LI Chunlin, DU Xiaoliang, FANG Jifeng, XU Chuan, ZHAO Kai, ZHANG Huaqiu. Establishment and clinical evaluation of artificial airway strategy in neurological coma patients[J]. Chinese Journal of Nursing, 2019, 54(6): 839-842.

胡娜, 厉春林, 杜晓亮, 方继锋, 许川, 赵恺, 张华楸. 神经外科昏迷患者人工气道管理方案的制订及实践[J]. 中华护理杂志, 2019, 54(6): 839-842.

References 15

[1]	中华医学会神经外科学分会. 神经外科重症管理专家共识(2013版)[J]. 中华医学杂志, 2013,93(23):1765-1779.
[2]	中华医学会重症医学分会. 机械通气临床应用指南(2006)[J]. 中国危重病急救医学, 2007,19(2):65-72.
[3]	黄德斌, 陈务贤, 宁传艺 . 国内持续气道湿化对人工气道湿化效果的Meta分析[J]. 护理研究, 2010,24(18):1603-1605.
[4]	崔君霞, 金奕, 于华 . 重型颅脑损伤患者气管切开早期采取不同吸痰方式的效果研究[J]. 中华护理杂志, 2013,48(2):124-126.
[5]	Alvarez-Lerma F, Palomar-Martinez M, Sanchez-Garcia M , et al. Prevention of ventilator-associated pneumonia:the multimodal approach of the spanish ICU“pneumonia zero” program[J]. Crit Care Med, 2018,46(2):181-188.
[6]	Pablo AM, Arturo RB, Alejandro HS , et al. Impact of strategic planning,organizational culture imprint and care bundles to reduce adverse events in the ICU[J]. Int J Qual Health Care, 2018.
[7]	邵春梅, 王淑敏 . ICU气管切开患者肺部感染危险因素分析及护理对策[J]. 中华现代护理杂志, 2016,22(15):2097-2100.
[8]	张京芬 . 集束化护理在重症颅脑损伤行机械通气患者中的应用效果[J]. 中华现代护理杂志, 2018,24(20):2452-2455.
[9]	Sun D, Zhao P, Ni JY , et al. Effects of airway management team in the treatment of severely mass burn patients combined with inhalation injury[J]. Zhonghua Shao Shang Za Zhi, 2018,34(6):354-359.
[10]	姜曼, 敖薪 . 人工气道管理标准的研究与应用现状[J]. 中华护理杂志, 2016,51(12):1479-1482.
[11]	吴彦烁, 宿桂霞, 尹彦玲 , 等. 4种临床因素对人工气道气囊压力的影响[J]. 中华护理杂志, 2017,52(8):934-937.
[12]	Rouze A, Martin-Loeches I, Nseir S . Airway devices in ventilator-associated pneumonia pathogenesis and prevention[J]. Clin Chest Med, 2018,39(4):775-783. DOI URL
[13]	Safdari R, Yazdannik A, Abbasi S . Effect of intermittent subglottic secretion drainage on ventilator-associated pneumonia:a clinical trial[J]. Iran J Nurs Midwifery Res, 2014,19(4):376-380.
[14]	Huang XA, Du YP, Fu BB , et al. Influence of subglottic secretion drainage on the microorganisms of ventilator associated pneumonia:a meta-analysis for subglottic secretion drainage[J]. Medicine(Baltimore), 2018,97(28):e11223.
[15]	Fujimoto H, Yamaguchi O, Hayami H , et al. Efficacy of continuous versus intermittent subglottic secretion drainage in preventing ventilator-associated pneumonia in patients requiring mechanical ventilation:a single-center randomized controlled trial[J]. Oncotarget, 2018,9(22):15876-15882.