早期纤维支气管镜灌洗吸痰对重型颅脑损伤气管切开患者的作用

摘要

目的:研究比较纤维支气管镜灌洗吸痰对重型颅脑损伤气管切开患者的应用效果.方法:选取2015年7月 ～2017年1月于我院接受气管切开行吸痰的重型颅脑损伤患者84例,根据随机数字表法将其等分为观察组和对照组,对照组患者予以常规护理干预,观察组在此基础上予以早期纤维支气管镜灌洗吸痰,比较两组患者护理前后的动脉血气指标水平变化情况、并发症发生情况.结果:观察组患者动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)分别为(108.8±32.5)mmHg、(322.4±112.6),均显著高于对照组的(94.5±29.1)mmHg、(270.5±80.5),而动脉血二氧化碳分压(PaCO2)为(37.1±5.0)mmHg,显著低于对照组的(41.4±7.0)mmHg,差异均有统计学意义(P<0.05);观察组患者气道黏膜出血、肺部感染发生率分别为7.14％(3/42),4.76％,均显著低于对照组的26.19％,19.05％,差异均有统计学意义(P<0.05).结论:早期纤维支气管镜灌洗吸痰应用于重型颅脑损伤患者气管切开中,可有效促进患者肺通气功能的恢复,降低并发症发生.%Objective:To study the application effect of bronchoscope suction lavage treatment on severe craniocerebral injury patients with tracheotomy. Methods:A total of 84 patients with severe craniocerebral injury who underwent tracheotomy in our hospital from July 2015 to January 2017 were selected and equally divided into observation group and control group according to random number table. While patients in control group were treated with routine nursing intervention,those in observation group were given early bronchoscope suction lavage treatment on the basis of routine nursing intervention. The changes of arterial blood gas index before and after treatment as well as the complications were compared between two groups. Results:The arterial partial pressure of oxygen (PaO2 )and oxygenation index (PaO2 / FiO2 )in the observation group were (108. 8 ± 32. 5)mmHg and (322. 4 ± 112. 6)respective-ly,which were significantly higher than those in the control group,(94. 5 ± 29. 1)mmHg and (270. 5 ± 80. 5)respectively;arterial partial pressure of carbon dioxide (PaCO2 )was (37. 1 ± 5. 0)mmHg,which was significantly lower than that of the control group,(41. 4 ± 7. 0)mmHg. The difference was statistical significance(P < 0. 05). The incidence of airway mucosal hemorrhage and pulmonary infection in the observation group was 7. 14％ (3 / 42)and 4. 76％ respectively,which were lower than that in the control group,26. 19％ and 19. 05％ respectively. The difference was statistical significance(P <0. 05). Conclusion:Early bronchoscope suction lavage treatment on severe craniocerebral injury patients with tracheotomy can effectively promote the recov-ery of pulmonary ventilation and reduce the incidence of complications.