一种改良气管套管固定带的研制及初步临床应用

发布时间：2018-06-11 10:05

本文选题：气管切开术 + 气管套管　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:研制一种安全、便捷、舒适的气管套管固定带,并评估其临床应用效果。方法:调查分析常用气管套管固定带的种类及临床应用现状,设计并自制一种改良气管套管固定带,其特征为并行双带+可拆卸连接件,通过并行双带的设计,增加固定带与患者皮肤的接触面积,提高佩戴舒适度;通过可拆卸连接件的设计达到无需松开全部的固定带即可完成辅料更换、固定带清洁的工作,最大程度降低了由于清洁固定带或提起固定带内衬保护垫等操作引起的脱管风险。选择2016年6月-2017年3月在山西医科大学第一医院耳鼻咽喉头颈外科、神经外科、神经内科、ICU科行气管切开术后的住院患者150例,随机分为3组,每组各50例,分别给予选取临床上常用的两种气管套管固定带,传统医用窄绷带(对照组A)、欣瑞德?导管固定装置(对照组B)与本研究设计的气管套管固定带(实验组)进行对比,观察并记录术后3天、7天、14天各个时点患者颈部皮肤损害的情况、患者舒适度、护理人员更换固定带、喉垫的难易程度、时间、频率以及患者意外脱管发生率等指标。结果:1.研制改良并行双带+可拆卸连接件气管套管固定带,并获得实用新型专利(专利号201620440991X)。2.参加试验的150例患者均完成试验,无失访和提前退出者,三组患者在年龄、性别、临床诊断、APACHEⅡ评分、Branden评分等方面比较,无统计学差异(P0.05),具有可比性。3.皮肤损害发生率比较,对照组A为22%,对照组B为14%,实验组为4%,三组患者差异有统计学意义(P0.05),组间比较,对照组A皮损率高于对照组B,对照组B高于实验组,差异有统计学意义(P0.05);患者颈部皮肤舒适度VAS评分比较,术后3天,对照组A患者VAS评分为(8.56±0.58),对照组B患者VAS评分为(7.36±0.69),实验组患者VAS评分为(3.98±0.84);术后7天,对照组A患者VAS评分为(7.48±0.65),对照组B患者VAS评分为(6.4±0.76),实验组患者VAS评分为(3.1±0.76);术后14天,对照组A患者VAS评分为(6.58±0.64),对照组B患者VAS评分为(5.74±0.75),实验组患者VAS评分为(2.4±0.64),三组患者术后3天、7天、14天患者佩戴舒适度差异均有统计学意义(P0.05),组间比较,各时间点实验组舒适度均高于对照组A、对照组B,对照组B高于对照组A,差异均有统计学意义(P0.05);给予患者使用不同固定带,护理人员更换难易程度VAS评分比较,对照组A为(7.06±1.11),对照组B为(6.22±1.02),实验组为(3.32±0.87),三组差异有统计学意义(P0.05),组间比较,实验组比对照组A、对照组B的固定带更换较容易,对照组B比对照组A更换较容易,差异均有统计学意义(P0.05);更换喉垫难易程度VAS评分比较,实验组为(3.22±0.86),对照组A为(6.60±0.73),对照组B为(6.46±0.84),实验组与对照组A、对照组B均有统计学意义(P0.05),对照组A和对照组B之间差异无统计学差异(P0.05);发生意外脱管情况比较,三组之间差异无统计学意义(P0.05)。结论:1.改良的气管套管固定带,符含固定带操作需求,安全、方便、有效。2.通过比较三组气管套管固定带的临床应用效果,发现本研究设计的气管套管固定带能显著减轻患者皮肤损害发生率、显著提高患者佩戴舒适度;护理人员更换改良固定带较为容易,耗时较短,且被污染时,可清洁、消毒,从而减少更换次数,减轻护理人员工作量,降低患者痛苦;喉垫更换较容易,且用时较短;套管脱出风险较低,更适用于气管切开患者,值得临床推广、应用。
[Abstract]:Objective: to develop a safe, convenient and comfortable tracheal tube fixed belt and evaluate its clinical application effect. Methods: To investigate and analyze the types and clinical application of common tracheal cannula, and to design and self-made a modified tracheal tube fixed belt, which is characterized by a parallel double band and detachable connector, and increased by parallel double band design. Fix the contact area with the skin of the patient to improve the wear comfort; through the design of the detachable connector to complete the replacement of the excipient without having to unlock all the fixed belts, the fixed belt cleaning work, the maximum reduction of the removal risk caused by the operation of the clean fixed belt or the fixed belt lining protection pad. Choose 2016 In March -2017 -2017 March, 150 hospitalized patients in the first hospital of Shanxi Medical University, otolaryngology head and neck surgery, Department of Neurosurgery, neurology, and ICU section were randomly divided into groups of 50 cases each, respectively, which were given two commonly used endotracheal tube fixation bands, traditional medical narrow bandage (control group A), and Xin Reed? Catheter The fixation device (control group B) was compared with the tracheal cannula fixed band (experimental group) designed by this study. The cases of cervical skin damage at 3 days, 7 days and 14 days after the operation were observed and recorded. The comfort degree of the patients, the replacement of the fixed belt, the difficulty of the larynx pad, the time, frequency and the incidence of accidental removal of the tube. Fruit: 1. to develop and improve the parallel double band + detachable connecting parts of the trachea cannula, and obtain a new patent (patent number 201620440991X).2. to participate in the test, all the patients completed the test. No loss of visits and early withdrawal, three groups of patients in age, sex, clinical diagnosis, APACHE II score, Branden score, and so on, no statistical difference. P0.05, compared with the ratio of.3. skin damage, the control group A was 22%, the control group B was 14%, the experimental group was 4%, the three groups were statistically significant (P0.05), compared with the control group, the A skin loss rate was higher than the control group B, the control group B was higher than the experimental group, the difference was statistically significant (P0.05); the neck skin comfort of the patients was compared to the VAS score. 3 days after operation, the VAS score of the control group A was (8.56 + 0.58), the VAS score of the control group was (7.36 + 0.69), the VAS score of the experimental group was (3.98 + 0.84), and the VAS score of the control group A patients was (7.48 + 0.65), and the VAS score of the control group of B patients was (6.4 + 0.76), and the VAS score of the experimental group was (3.1 + 0.58). The score was (6.58 + 0.64). The VAS score of the control group was (5.74 + 0.75) and the VAS score of the experimental group was (2.4 + 0.64). The difference of comfort degree between the three groups of patients at 3 days, 7 days and 14 days was statistically significant (P0.05). The comparison between the groups was higher than that of the control group A, the control group was B, and the control group B was higher than the control group A, the difference was all There was statistical significance (P0.05); the patients were given different fixed bands, and the VAS scores of the nurses were compared, the control group A was (7.06 + 1.11), the control group B was (6.22 + 1.02), the experimental group was (3.32 + 0.87), the three groups were statistically significant (P0.05), the experimental group was A and the control group was more easy to replace the B in the control group. The change of B in group A was more easy than that of the control group (P0.05); the experimental group was (3.22 + 0.86), the control group was (6.60 + 0.73), the control group was (6.60 + 0.73), and the control group B was (6.46 + 0.84), the experimental group and the control group were A, and the control group B had statistical significance (P0.05). There was no statistical difference between the control group A and the control group B. The difference (P0.05); there was no significant difference between the three groups (P0.05). Conclusion: 1. improved tracheal cannula fixation belt, which contains the fixed belt operation demand, is safe and convenient, and effective.2. can be significantly reduced by comparing the clinical effect of three groups of tracheal cannula fixed belts. The incidence of skin damage in light patients is significantly improved, and the comfort degree of the patients is significantly improved; the nurses are easier to replace the modified fixed belt, shorter time consuming, and can be cleaned and sterilized when they are polluted, thus reducing the number of replacement, reducing the workload of the nursing staff and reducing the pain of the patients; the replacement of the larynx pad is easier and shorter; the risk of casing removal is lower and more suitable. For tracheotomy patients, it is worthy of clinical promotion and application.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472

【参考文献】