人工鼻气道湿化吸痰在ICU危重患者气管切开周围皮肤预见性护理中的效果观察
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摘要
目的:探讨人工鼻在ICU危重患者气管切开周围皮肤预见性护理中的应用效果。方法:选择行气管切开的患者212例,随机分为两组:病例组和对照组,每组106例,两组患者使用的气管切开套管均为同一厂家产品。对照组患者按照气管切开术后常规护理,使用小包装无菌纱布更换敷料,给予间断或定时气道湿化;病例组在气管切开术后常规护理的基础上进行预见性护理,使用人工鼻气道湿化。两组敷料污染后及时更换,细心观察,精心护理。结果:病例组患者敷料更换频次为(3.02±0.76)次/例、吸痰频次(23.92±2.44)次/例、日均直接经济成本(132.97±5.88)元、皮肤不良反应发生率为1.89%;对照组分别为(4.97±0.83)次/例、(28.02±4.62)次/例、(171.56±3.10)元及15.09%,两组比较差异有统计学意义(t_1=-17.74、t_2=-8.04、t_3-59.77、χ~2=11.90,均P<0.01)。结论:使用人工鼻对气管切开患者进行预见性护理,可以过滤吸入气体、维持气道湿化温化,提高呼吸道防御机能,同时可减少痰液分泌量、日更换敷料频次和吸痰频次,降低呼吸道管理日均直接经济成本,有效预防气管切口周围皮肤痰液浸渍等引起的不良反应。
Objective:To discuss the applied efficacy of artificial nasal airway in predictive skin nursing surround the tracheotomy on ICU patients with critical illness.Methods:Selected 212 patients received tracheotomy in our hospital ICU from divided them into two groups,which were the case group and the control group,with 106 cases in each group,tracheostomy tube used in both groups were produced by the same manufacturer.Gave patients in the control group routine nursing after the tracheotomy,changed dressings with small packed sterile dressings,and gave intermittent or regular airway humidification,gave patients in the case group prospective nursing with artificial nasal airway humidification based on routine nursing after the tracheotomy.Dressings of the two groups were timely replaced after the contamination,gave careful observation and meticulous nursing.Results:Replaced frequency of dressings in the case group was(3.02±0.76)times/case,whose suctioning frequency was(23.92±2.44)times/case,the daily average direct economic cost was(132.97±5.88),the incidence of skin adverse reaction was 1.89%,which in the control group was(497±0.83)times/case,(28.02±4.62)times/case,171.56±3.10 and 15.09%in sequence,compared these two groups,whose difference was statistically significant(t_1=-17.74,t_2=-8.04,t_3-59.77,χ~2=11.90,all P<0.01).After the tracheotomy,gave the case group predictive nursing,use of artificial nose can ensure the respiratory air humid and temperature effectively,reduce skin complications around the incision,and improve the quality of respiratory and skin management.Conclusion:Giving patients underwent tracheostomy predictive nursing with artificial nose can filter inhaled gas,maintain airway humid and warm,improve respiratory defense function,and can reduce the amount of sputum secretion,dressing replaced frequency and suction frequency,reduce the daily average direct economic cost of respiratory tract management at the same time,to prevent adverse reactions caused by sputum dipping the skin around the racheal incision effectively.
Objective:To discuss the applied efficacy of artificial nasal airway in predictive skin nursing surround the tracheotomy on ICU patients with critical illness.Methods:Selected 212 patients received tracheotomy in our hospital ICU from divided them into two groups,which were the case group and the control group,with 106 cases in each group,tracheostomy tube used in both groups were produced by the same manufacturer.Gave patients in the control group routine nursing after the tracheotomy,changed dressings with small packed sterile dressings,and gave intermittent or regular airway humidification,gave patients in the case group prospective nursing with artificial nasal airway humidification based on routine nursing after the tracheotomy.Dressings of the two groups were timely replaced after the contamination,gave careful observation and meticulous nursing.Results:Replaced frequency of dressings in the case group was(3.02±0.76)times/case,whose suctioning frequency was(23.92±2.44)times/case,the daily average direct economic cost was(132.97±5.88),the incidence of skin adverse reaction was 1.89%,which in the control group was(497±0.83)times/case,(28.02±4.62)times/case,171.56±3.10 and 15.09%in sequence,compared these two groups,whose difference was statistically significant(t_1=-17.74,t_2=-8.04,t_3-59.77,χ~2=11.90,all P<0.01).After the tracheotomy,gave the case group predictive nursing,use of artificial nose can ensure the respiratory air humid and temperature effectively,reduce skin complications around the incision,and improve the quality of respiratory and skin management.Conclusion:Giving patients underwent tracheostomy predictive nursing with artificial nose can filter inhaled gas,maintain airway humid and warm,improve respiratory defense function,and can reduce the amount of sputum secretion,dressing replaced frequency and suction frequency,reduce the daily average direct economic cost of respiratory tract management at the same time,to prevent adverse reactions caused by sputum dipping the skin around the racheal incision effectively.
引文
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[15]荣再香,李雪英,李艳华,等.预见性护理程序在颅骨缺损伴脑积水同期手术护理中的应用[J].护理实践与研究,2013,10(8):44.
[16]马惠.人工鼻在人工气道应用中的护理进展[J].右江医学杂志,2010,38(2):219.
[17]罗春霞,刘妙秋.集束化护理在老年危重患者人工气道管理中的应用[J].护理实践与研究,2017,14(16):129.
[2]施丽华.人工鼻在气管切开病人中的应用及护理[C].//浙江省神经外科学学术年会暨浙闽江赣四省神经外科学术交流会,2015:619-621.
[3]北京协和医院.临床护理常规[M].3版.北京:人民卫生出版社,2012:364.
[4]张波,桂莉.急危重症护理学[M].3版.北京:人民卫生出版社,2012:245-246.
[5]吴永彪,马艳丽.持续负压吸引在气管切开术后高气道分泌物卧床患者护理中的效果观察[J].中国实用护理杂志,2016,32(13):1016-1017.
[6]高云,薛红丽,贾红兵,等.康惠尔溃疡贴治疗创伤性皮肤缺损的效果观察[J].西北国防医学杂志,2011,32(5):388.
[7]尤丽丽.康惠尔泡沫敷料在气管切开伤口中的应用[J].中华现代护理杂志,2008,43(8):707-708.
[8]岳爽.老年住院患者意外伤害风险评估及预见性护理[J].护理实践与研究,2013,10(7):110.
[9]孙燕飞,张玉琴.新型敷料在骨科难愈性伤口中的应用体会[J].中国实用护理杂志,2016,32(17):1038-1039.
[10]张波,桂莉.急危重症护理学[M].3版.北京:人民卫生出版社,2012:280-281.
[11]胡晓琳,赵玲莉.人工鼻在人工气道患者中的应用与护理[J].四川省卫生管理学院学报,2008,12(27):284-285.
[12]欧美金,谢淑芬,谢瑞香.探讨人工鼻在人工气道患者中的应用效果[J].国际医学卫生导报,2008,17(14):57-58.
[13]孙亮.人工鼻在人工气道患者气道湿化中的应用[J].河南职工医学院学报,2011,5(23):579.
[14]韩秀华.人工鼻在人工气道患者湿化气道中应用的效果观察[J].护理学报,2006,13(2):12-14.
[15]荣再香,李雪英,李艳华,等.预见性护理程序在颅骨缺损伴脑积水同期手术护理中的应用[J].护理实践与研究,2013,10(8):44.
[16]马惠.人工鼻在人工气道应用中的护理进展[J].右江医学杂志,2010,38(2):219.
[17]罗春霞,刘妙秋.集束化护理在老年危重患者人工气道管理中的应用[J].护理实践与研究,2017,14(16):129.