联合吸痰法在心外科术后肺部感染中的应用研究
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摘要
目的研究密闭式吸痰法联合纤维支气管镜吸痰法在心外科术后肺部感染中的效果。方法选取2016年9月-2017年8月心脏外科手术患者128例,随机分为观察组和对照组(各64例)。观察组采用密闭式吸痰法联合纤维支气管镜吸痰法、对照组采用密闭式吸痰法,观察两组患者术后肺部感染率、感染控制效果和吸痰量、吸痰次数及临床表现消失时间、抗菌药物使用时间、住院时间及心肺功能参数。结果对照组术后肺部感染14例、感染率21.88%,高于观察组术后肺部感染率6.25%(P<0.05)。观察组术后肺部感染临床控制率48.44%、总有效率93.75%均高于对照组(P<0.05)。观察组每日吸痰次数少于对照组,每次吸出痰液量多于对照组(P<0.05)。吸痰后,观察组PaO2、PaO2/FiO2及其差值高于对照组(P<0.05)。观察组体温恢复、咳嗽咳痰消失、肺部啰音消失、胸片显示炎症消失时间、抗菌药物使用时间、住院时间均少于对照组(P<0.05)。结论密闭式吸痰法联合纤维支气管镜吸痰法能及时、有效促进心脏外科术后患者气道痰液彻底排出,保证气道通畅,有助于降低术后肺部感染率和抗菌药物使用率,更好地促进了心外科患者术后机体功能恢复。
OBJECTIVE To explore the effect of closed suction method combined with fiberoptic bronchoscopy suction on prevention of postoperative pulmonary infection in patients of cardiac surgery department.METHODS A total of 128 patients who received cardiac surgery from Sep 2016 to Aug 2017 were enrolled in the study and randomly divided into the observation group and the control group,with 64 cases in each group.The observation group was treated with closed suction method combined with fiberoptic bronchoscopy suction,while the control group was treated with closed suction method.The incidence of postoperative pulmonary infection,effect of infection control,sputum suction amount,number of times of suction,time of disappearance of clinical manifestations,time of use of antibiotics,length of hospital stay and cardio-pulmonary function parameters were observed and compared between the two groups of patients.RESULTS The incidence rate of postoperative pulmonary infection of the control group was 21.88%(14 cases),higher than 6.25% of the observation group(P<0.05).The rate of clinical control of postoperative pulmonary infection and total effective rate of the observation group were respectively 48.44% and 93.75%,significantly higher than those of the control group(P<0.05).The number of times of daily suction of the observation group was significantly less than that of the control group,while the sputum suction amount of the observation group was significantly more than that of the control group(P<0.05).The PaO2 level,PaO2/FiO2 and the difference value were significantly higher in the observation group than in the control group after the suction(P<0.05).The time of recovery of body temperature,time of disappearance of pulmonary rales,time of disappearance of inflammation displayed in chest image,time of use of antibiotics and length of hospital stay were significantly shorter in the observation group than in the control group(P <0.05).CONCLUSION The closed suction method combined with fiberoptic bronchoscopy suction may effectively facilitate the completed discharge of airway sputum of cardiac surgery department patients,keep the airway clear,reduce the incidence of postoperative pulmonary infection and utilization rate of antibiotics,and promote the postoperative functional recovery.
OBJECTIVE To explore the effect of closed suction method combined with fiberoptic bronchoscopy suction on prevention of postoperative pulmonary infection in patients of cardiac surgery department.METHODS A total of 128 patients who received cardiac surgery from Sep 2016 to Aug 2017 were enrolled in the study and randomly divided into the observation group and the control group,with 64 cases in each group.The observation group was treated with closed suction method combined with fiberoptic bronchoscopy suction,while the control group was treated with closed suction method.The incidence of postoperative pulmonary infection,effect of infection control,sputum suction amount,number of times of suction,time of disappearance of clinical manifestations,time of use of antibiotics,length of hospital stay and cardio-pulmonary function parameters were observed and compared between the two groups of patients.RESULTS The incidence rate of postoperative pulmonary infection of the control group was 21.88%(14 cases),higher than 6.25% of the observation group(P<0.05).The rate of clinical control of postoperative pulmonary infection and total effective rate of the observation group were respectively 48.44% and 93.75%,significantly higher than those of the control group(P<0.05).The number of times of daily suction of the observation group was significantly less than that of the control group,while the sputum suction amount of the observation group was significantly more than that of the control group(P<0.05).The PaO2 level,PaO2/FiO2 and the difference value were significantly higher in the observation group than in the control group after the suction(P<0.05).The time of recovery of body temperature,time of disappearance of pulmonary rales,time of disappearance of inflammation displayed in chest image,time of use of antibiotics and length of hospital stay were significantly shorter in the observation group than in the control group(P <0.05).CONCLUSION The closed suction method combined with fiberoptic bronchoscopy suction may effectively facilitate the completed discharge of airway sputum of cardiac surgery department patients,keep the airway clear,reduce the incidence of postoperative pulmonary infection and utilization rate of antibiotics,and promote the postoperative functional recovery.
引文
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[12]Sadot E,Gut G,Sivan Y.Alveolar ventilation in children during flexible bronchoscopy[J].Pediatr Pulmonol,2016,51(11):1177-1182.
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[14]Irajpour A,Abbasinia M,Hoseini A,et al.Effects of shallow and deep endotracheal tube suctioning on cardiovascular indices in patients in intensive care units[J].Iran J Nurs Midwifery Res,2014,19(4):366-370.
[15]张继凤,杨侃,曹博,等.心脏外科术后下呼吸道感染患者采用密闭式吸痰联合纤维支气管镜的应用效果分析[J].中华医院感染学杂志,2017,27(6):1293-1296.
[2]吉家聪,邓镇生.纤维支气管镜吸痰用于心胸外科术后机械通气并发肺部感染的疗效分析[J].临床肺科杂志,2017,22(7):1263-1266.
[3]Lau AC,So HM,Tang SL,et al.Prevention of ventilator-associated pneumonia[J].Hong Kong Med J,2015,21(1):61-68.
[4]Hsieh CH,Lin TY,Wang TY,et al.The safety and efficacy of alfentanil-based induction in bronchoscopy sedation:a randomized,double-blind,controlled trial[J].Medicine(Baltimore),2016,95(43):e5101.
[5]曾建明,曾春芳,冯银合,等.纤维支气管镜灌洗对重症肺部感染患者的疗效[J].中华医院感染学杂志,2016,26(6):1303-1305.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,85(5):314-320
[7]王宇明,施光峰,等.感染病学[R].第2版.北京:人民卫生出版社,2010:8-13.
[8]Rognas L,Hansen TM,Kirkegaard H,et al.Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury:an observational study[J].Eur J Emerg Med,2014,21(6):418-423.
[9]Hamishekar H,Shadvar K,Taghizadeh M,et al.Ventilatorassociated pneumonia in patients admitted to intensive care units,using open or closed endotracheal suctioning[J].Anesth Pain Med,2014,4(5):e21649.
[10]Abbasinia M,Irajpour A,Babaii A,et al.Comparison the effects of shallow and deep endotracheal tube suctioning on respiratory rate,arterial blood oxygen saturation and number of suctioning in patients hospitalized in the intensive care unit:a randomized controlled trial[J].J Caring Sci,2014,3(3):157-164.
[11]范江花,张新萍,胥志跃,等.纤维支气管镜检查和肺泡灌洗术在重症肺部感染中应用意义[J].中国小儿急救医学,2015,22(7):449-453.
[12]Sadot E,Gut G,Sivan Y.Alveolar ventilation in children during flexible bronchoscopy[J].Pediatr Pulmonol,2016,51(11):1177-1182.
[13]盘健.纤维支气管镜肺泡灌洗吸痰术对ICU患者肺部感染的疗效研究[J].现代诊断与治疗,2017,28(3):556-558.
[14]Irajpour A,Abbasinia M,Hoseini A,et al.Effects of shallow and deep endotracheal tube suctioning on cardiovascular indices in patients in intensive care units[J].Iran J Nurs Midwifery Res,2014,19(4):366-370.
[15]张继凤,杨侃,曹博,等.心脏外科术后下呼吸道感染患者采用密闭式吸痰联合纤维支气管镜的应用效果分析[J].中华医院感染学杂志,2017,27(6):1293-1296.