摘要
目的 将循证护理概念应用于人工气道患者难置胃管的实践中,介绍自制导引器的使用方法,并观察其应用效果.方法 选择2016年4至12月河北医科大学附属哈励逊国际和平医院重症医学科（ICU）收治的40例建立人工气道难置胃管患者作为观察组,通过循证护理策略,检索国内外相关文献,查找临床证据,制定并实施护理方案,应用喉镜直视下自制导引器置入胃管.以2015年8月至2016年3月采用喉镜直视下直接放置胃管的36例难置胃管患者作为历史对照组.比较两组患者一次性置管成功率、置管时间及喉头水肿、咽部黏膜出血等并发症发生情况.结果 所有患者均纳入最终分析.对照组中一次性置管成功28例,失败8例;而观察组中仅1例患者置管失败,经对症处理后再次置管成功,其一次性置管成功率明显高于对照组（97.5%比77.8%）,且置管时间较对照组明显缩短（min：4.8±1.2比5.1±1.0）,差异有统计学意义（均P〈0.05）.对照组患者中有2例发生喉头水肿,4例发生咽部黏膜出血;而观察组应用喉镜下自制导引器置入胃管,无喉头水肿发生,仅1例患者发生咽部黏膜出血.结论 应用自制导引器可明显提高难置胃管患者的一次性置管成功率,并缩短置管时间,且在减少并发症方面优于传统胃管置入法.
Objective To use evidence-based nursing on patients with artificial airway to the practice of stomach tube, and to evaluate the self made guidance for difficult gastric tube placement in patients with artificial airway.Methods Forty patients with artificial airway and were difficult to put the tube, and admitted to Department of Critical Care Medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University from April to December in 2016 were enrolled as observation group. Through the evidence-based nursing strategy, the related literatures at home and abroad were collected to search clinical evidence and formulate and implement the nursing program, the gastric tube was inserted into the stomach tube under the direct vision of the laryngoscope. Thirty-six patients of difficult gastric tube placement with artificial airway straightly under the direct vision of the laryngoscope from August 2015 to March 2016 were retrospectively analyzed as the control group. The success rate of first catheterization, indwelling time, throat edema and bleeding of pharyngeal mucosa were compared between the two groups.Results All patients were enrolled in the final analysis. In the control group, 28 patients were successfully placed once, while 8 failed. Only 1 patient in observation group failed to catheterize, and successful placed after symptomatic treatment, the one-time success rate of catheter was significantly higher than that of control group （97.5% vs. 77.8%）, and catheter time was significantly shortened （minutes： 4.8±1.2 vs. 5.1±1.0）, the difference was statistically significant （bothP 〈 0.05）. There were 2 patients with laryngeal edema in the control group and 4 patients of pharyngeal mucosal hemorrhage. In the observation group, there was no laryngealedema and laryngeal edema occurred in the patients with laryngoscopy, and only 1 patient had a hemorrhage of pharyngeal mucosa.Conclusion Using self made guiding device can effectively insert the difficult gastric tube in patients with artificial airway, and increase the one-time success rate of intubation, shorten the catheter time, and have a trend in reduce complication as compared with traditional gastric tube placement.
作者
陈晓洁
张谨超
李文秀
姜义卿
林灵芝
Chen Xiaojie Zhang Jinchao Li Wenxiu Jiang Yiqing Lin Lingzhi(Department of Nursing, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, Hebei, Chin Department of Critica! Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, Hebei, Chin)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第9期840-843,共4页
Chinese Critical Care Medicine
基金
国家实用新型专利（ZL201420167489.7）
河北省衡水市科技计划项目（2016014099Z）
关键词
人工气道
难置胃管
自制导引器
喉镜
循证实践
Artificial airway
Difficult tube placement
Self made guiding device
Visual laryngoscope
Evidence-based practice
