[1]项丽君,曹猛,宋学梅,等.吸痰时咳嗽强度对气囊压力不达标的预测价值[J].军事护理,2022,39(02):46-50.[doi:10.3969/j.issn.1008-9993.2022.02.012]
 XIANG Lijun,CAO Meng,SONG Xuemei,et al.Predictive Value of Cough Strength During Sputum Suction on Substandard Cuff Pressure[J].Nursing Journal Of Chinese People's Laberation Army,2022,39(02):46-50.[doi:10.3969/j.issn.1008-9993.2022.02.012]
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吸痰时咳嗽强度对气囊压力不达标的预测价值
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《军事护理》[ISSN:2097-1826/CN:31-3186/R]

卷:
39
期数:
2022年02期
页码:
46-50
栏目:
研究荟萃
出版日期:
2022-02-15

文章信息/Info

Title:
Predictive Value of Cough Strength During Sputum Suction on Substandard Cuff Pressure
文章编号:
1008-9993(2022)02-0046-05
作者:
项丽君12曹猛1宋学梅1王园12罗彦嗣1高贺发1张晓梅1
(1.南方医科大学南方医院 神经内科,广东 广州 510515; 2.南方医科大学 护理学院,广东 广州 510515)
Author(s):
XIANG Lijun12CAO Meng1SONG Xuemei1WANG Yuan12LUO Yansi1GAO Hefa1ZHANG Xiaomei1
(1.Department of Neurology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, Guangdong Province, China; 2.School of Nursing, Southern Medical University, Guangzhou 510515, Guangdong Province, China)
关键词:
气囊压力 吸痰 咳嗽强度 预测价值
Keywords:
cuff pressure sputum suction cough strength predictive value
分类号:
R472
DOI:
10.3969/j.issn.1008-9993.2022.02.012
文献标志码:
A
摘要:
目的 探讨吸痰时咳嗽强度对气囊压力不达标的预测价值,旨在为个性化校正气囊压力提供参考。方法 2020年6月至2021年2月,便利选取某院50例建立人工气道的患者,采用半定量咳嗽强度评分法(semi-quantitative cough strength score,SCSS)评估吸痰时咳嗽强度,分析咳嗽强度与气囊压力不达标的相关性,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算预测气囊压力不达标的咳嗽强度临界值。结果 SCSS 5分组吸痰时(最大值)的气囊压力为(88.67±8.04)cmH2O(1 cmH2O=0.098 kPa)。SCSS 4~5分组吸痰后20 min时气囊压力均低于正常范围,5分组平均损失8.50 cmH2O,不达标率为92.68%。吸痰时咳嗽强度对气囊压力的影响存在组别、时间和交互效应(P<0.001)。吸痰时咳嗽强度与气囊压力不达标呈中度正相关(r=0.563,P<0.001),ROC曲线下面积为0.820(P<0.001),最佳界值3.5,灵敏度0.716,特异度0.847。结论 吸痰时咳嗽强度对气囊压力不达标具有良好的预测价值,当SCSS评分≥4分时,建议吸痰后10 min重新校正气囊压力。
Abstract:
Objective To evaluate the predictive value of cough strength during suction on substandard cuff pressure, and to provide references for targeted adjustment of cuff pressure.Methods From June 2020 to February 2021, 50 patients who had been established an artificial airway in a hospital were selected as study subjects by convenience sampling method.The semi-quantitative cough strength score(SCSS)was used to evaluate the cough strength during sputum suction.The correlation between cough strength during suction and substandard cuff pressure was analyzed, and the receiver operating characteristic(ROC)curve was drawn to calculate the critical value of cough strength for substandard cuff pressure.Results The maximum cuff pressure value during sputum suction in the group with SCSS of 5 was(88.67±8.04)cmH2O.In the group with SCSS of 4-5, the cuff pressure values were lower than the normal range.The cuff pressure loss in the group with SCSS of 5 was 8.50 cmH2O, and the substandard rate was 92.68%.The cough strength during sputum suction influenced the cuff pressure in terms of group, time and interaction differences(all P<0.001).The cough strength during suction was positively correlated with the substandard cuff pressure(r=0.563, P<0.001).The area under ROC curve was 0.820(P<0.001), with a cutoff value of 3.5, sensitivity and specificity values of 0.716 and 0.847, respectively.Conclusions The cough strength during sputum suction has a good predictive value for the substandard cuff pressure.When the SCSS is greater than or equal to 4, it is recommended to recalibrate the cuff pressure at 10 min after suction.

参考文献/References:

[1] SHI Y,HUANG Y,ZHANG T T,et al.Chinese guidelines for the diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in adults(2018 Edition)[J].J Thorac Dis,2019,11(6):2581-2616.
[2] KLOMPAS M,BRANSON R,EICHENWALD E C,et al.Strategies to prevent ventilator-associated pneumonia in acute care hospitals:2014 update[J].Infect Cont Hosp Ep,2014,35(S2):S133-S154.
[3] 中华医学会呼吸病学分会呼吸治疗学组.人工气道气囊的管理专家共识(草案)[J].中华结核和呼吸杂志,2014,37(11):816-819.
[4] NAZARI R,BOYLE C,PANJOO M,et al.The changes of endotracheal tube cuff pressure during manual and intermittent controlling in intensive care units[J].Iran J Nurs Midwife,2020,25(1):71-75.
[5] GIUSTI G D,ROGARI C,GILI A,et al.Cuff pressure monitoring by manual palpation in intubated patients:how accurate is it?A manikin simulation study[J].Aust Crit Care,2017,30(4):234-238.
[6] 周丹,席惠君.护理操作对机械通气患者气囊压力变化的影响研究[J].护士进修杂志,2019,34(22):2100-2103.
[7] 王元元,汪明灯,程静娟,等.气囊压力动态变化及预防渗漏的临床研究[J].中华重症医学电子杂志,2020,6(4):404-410.
[8] ALCAN A O,VAN GIERSBERGEN M Y,DINCARSLAN G,et al.Effect of patient position on endotracheal cuff pressure in mechanically ventilated critically ill patients[J].Aust Crit Care,2017,30(5):267-272.
[9] PARSIAN Z,RAHMANI F,MAHMOODPOOR A,et al.Association between core body temperature and mean airway pressure with endotracheal cuff pressure in intubated patients of emergency department[J].Pak J Med Sci,2019,35(5):1248-1252.
[10]KHAMIEES M,RAJU P,DEGIROLAMO A,et al.Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial[J].Chest,2001,120(4):1262-1270.
[11]IBRAHIM A S,ALY M G,ABDEL-RAHMAN K A,et al.Semiquantitative cough strength score as a predictor for extubation outcome in traumatic brain injury:a prospective observational study[J].Neurocrit Care,2018,29(2):273-279.
[12]NAZARI R,NIA H S,HAJIHOSSEINI F,et al.Effect of tracheal suctioning on cuff pressure in mechanically ventilated patients:a quasi-experimental study[J].Tanaffos,2021,20(1):22-28.
[13]吴彦烁,宿桂霞,尹彦玲,等.4种临床因素对人工气道气囊压力的影响[J].中华护理杂志,2017,52(8):934-937.
[14]SOLE M L,SU X G,TALBERT S,et al.Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range[J].Am J Crit Care,2011,20(2):109-117.
[15]ZAPATA-ARRIAZA E,SERRANO-GOTARREDONA P,NAVARRO-HERRERO S,et al.Chest computed tomography findings and validation of clinical criteria of stroke associated pneumonia[J].J Stroke,2019,21(2):217-219.
[16]O'NEILL M P,GOPALAN P D.Endotracheal tube cuff pressure change:proof of concept for a novel approach to objective cough assessment in intubated critically ill patients[J].Heart Lung,2020,49(2):181-185.
[17]DAVE M H,FROTZLER A,WEISS M.Closed tracheal suction and fluid aspiration past the tracheal tube.Impact of tube cuff and airway pressure[J].Minerva Anestesiol,2011,77(2):166-171.
[18]关欣,杨慧,李栩亭,等.成人有创机械通气气道分泌物吸引的现状调查[J].中华护理杂志,2020,55(6):922-927.

备注/Memo

备注/Memo:
【 收稿日期 】 2021-06-10 【 修回日期 】 2022-01-06
【 基金项目 】 南方医科大学南方医院院长基金(2020H002)
【 作者简介 】 项丽君,在读硕士,护师,从事神经急危重症护理
【 通信作者 】 张晓梅,电话:020-62787664
更新日期/Last Update: 2022-02-15