目的:评价吸痰4种临床护理程序前后气管套囊压力的动态变化,口腔护理,雾化吸入,翻身,从而为临床上调整袖带压力的时间提供参考。
背景:袖口压力必须保持在25-30cmH2O的范围内,以确保有效通气并防止吸气,同时维持气管血流灌注。
方法:一项前瞻性观察性研究。
方法:将56例插管患者的袖带压力调整为28-30cmH2O。使用袖带压力监测器在四个临床护理程序(吸痰,口腔护理,雾化吸入,和翻转)并比较了各个时间点的袖带压力。半定量咳嗽强度评分(SCSS)用于评估吸痰过程中的咳嗽强度以及吸痰过程中咳嗽强度对袖带压力的影响。这项研究遵循STROBE清单进行横断面研究。
结果:吸痰四种临床护理过程中的袖带压力,雾化吸入,翻身,和口腔护理,所有都暂时增加(p<0.001),20分钟后下降到不同程度(p<0.001)。其中,在吸痰过程中中度或强烈咳嗽状态下,袖带压力最高(78.38±12.13cmH2O),在手术后20分钟下降最大(21.71±4.80cmH2O)。
结论:吸痰的四种临床护理程序,雾化吸入,翻身,和口腔护理都会引起不同程度的袖带压降。关于是否需要校正袖带压力的决定取决于具体情况。
结论:在临床实践中,可以根据不同的临床护理程序单独校正袖带压力,提高了袖带压力的合格率,减少了护士的工作量。
OBJECTIVE: To evaluate the dynamic changes in tracheal cuff pressure before and after four clinical nursing procedures including sputum suction, oral care, atomisation inhalation, and turning over, and thus provide references for the adjustment time of cuff pressure in clinical practice.
BACKGROUND: Cuff pressure must be kept within the range of 25-30 cmH2 O to ensure effective ventilation and prevent aspiration, while maintaining tracheal blood flow perfusion.
METHODS: A prospective observational study.
METHODS: The cuff pressure of 56 intubated patients was adjusted to 28-30 cmH2 O. A cuff pressure monitor was used to continuously monitor cuff pressure changes before and after four clinical nursing procedures (sputum suction, oral care, atomisation inhalation, and turning over) and the cuff pressures at various time points were compared. The semi-quantitative cough strength score (SCSS) was used to evaluate cough strength during sputum suction and the effect of cough strength on cuff pressure during sputum suction. This study followed the STROBE checklist for cross-sectional studies.
RESULTS: The cuff pressures during the four clinical nursing procedures of sputum suction, atomisation inhalation, turning over, and oral care, all temporarily increased (p < 0.001) and decreased to varying degrees 20 min later (p < 0.001). Among them, the cuff pressure rose the highest under a state of moderate or strong coughing during sputum suction (78.38 ± 12.13 cmH2 O) and dropped the most at 20 min after the procedure (21.71 ± 4.80 cmH2 O).
CONCLUSIONS: The four clinical nursing procedures of sputum suction, atomisation inhalation, turning over, and oral care can all cause different degrees of cuff pressure drop. The decision on whether the cuff pressure needs to be corrected depends on the specific situation.
CONCLUSIONS: During clinical practice, the cuff pressure can be individually corrected according to different clinical nursing procedures, which can increase the qualified rate of cuff pressure and reduce the workload of nurses.