本文選題：氣管切開術(shù) + 氣管套管�。� 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:研制一種安全、便捷、舒適的氣管套管固定帶,并評估其臨床應(yīng)用效果。方法:調(diào)查分析常用氣管套管固定帶的種類及臨床應(yīng)用現(xiàn)狀,設(shè)計并自制一種改良氣管套管固定帶,其特征為并行雙帶+可拆卸連接件,通過并行雙帶的設(shè)計,增加固定帶與患者皮膚的接觸面積,提高佩戴舒適度;通過可拆卸連接件的設(shè)計達到無需松開全部的固定帶即可完成輔料更換、固定帶清潔的工作,最大程度降低了由于清潔固定帶或提起固定帶內(nèi)襯保護墊等操作引起的脫管風險。選擇2016年6月-2017年3月在山西醫(yī)科大學第一醫(yī)院耳鼻咽喉頭頸外科、神經(jīng)外科、神經(jīng)內(nèi)科、ICU科行氣管切開術(shù)后的住院患者150例,隨機分為3組,每組各50例,分別給予選取臨床上常用的兩種氣管套管固定帶,傳統(tǒng)醫(yī)用窄繃帶(對照組A)、欣瑞德?導(dǎo)管固定裝置(對照組B)與本研究設(shè)計的氣管套管固定帶(實驗組)進行對比,觀察并記錄術(shù)后3天、7天、14天各個時點患者頸部皮膚損害的情況、患者舒適度、護理人員更換固定帶、喉墊的難易程度、時間、頻率以及患者意外脫管發(fā)生率等指標。結(jié)果:1.研制改良并行雙帶+可拆卸連接件氣管套管固定帶,并獲得實用新型專利(專利號201620440991X)。2.參加試驗的150例患者均完成試驗,無失訪和提前退出者,三組患者在年齡、性別、臨床診斷、APACHEⅡ評分、Branden評分等方面比較,無統(tǒng)計學差異(P0.05),具有可比性。3.皮膚損害發(fā)生率比較,對照組A為22%,對照組B為14%,實驗組為4%,三組患者差異有統(tǒng)計學意義(P0.05),組間比較,對照組A皮損率高于對照組B,對照組B高于實驗組,差異有統(tǒng)計學意義(P0.05);患者頸部皮膚舒適度VAS評分比較,術(shù)后3天,對照組A患者VAS評分為(8.56±0.58),對照組B患者VAS評分為(7.36±0.69),實驗組患者VAS評分為(3.98±0.84);術(shù)后7天,對照組A患者VAS評分為(7.48±0.65),對照組B患者VAS評分為(6.4±0.76),實驗組患者VAS評分為(3.1±0.76);術(shù)后14天,對照組A患者VAS評分為(6.58±0.64),對照組B患者VAS評分為(5.74±0.75),實驗組患者VAS評分為(2.4±0.64),三組患者術(shù)后3天、7天、14天患者佩戴舒適度差異均有統(tǒng)計學意義(P0.05),組間比較,各時間點實驗組舒適度均高于對照組A、對照組B,對照組B高于對照組A,差異均有統(tǒng)計學意義(P0.05);給予患者使用不同固定帶,護理人員更換難易程度VAS評分比較,對照組A為(7.06±1.11),對照組B為(6.22±1.02),實驗組為(3.32±0.87),三組差異有統(tǒng)計學意義(P0.05),組間比較,實驗組比對照組A、對照組B的固定帶更換較容易,對照組B比對照組A更換較容易,差異均有統(tǒng)計學意義(P0.05);更換喉墊難易程度VAS評分比較,實驗組為(3.22±0.86),對照組A為(6.60±0.73),對照組B為(6.46±0.84),實驗組與對照組A、對照組B均有統(tǒng)計學意義(P0.05),對照組A和對照組B之間差異無統(tǒng)計學差異(P0.05);發(fā)生意外脫管情況比較,三組之間差異無統(tǒng)計學意義(P0.05)。結(jié)論:1.改良的氣管套管固定帶,符含固定帶操作需求,安全、方便、有效。2.通過比較三組氣管套管固定帶的臨床應(yīng)用效果,發(fā)現(xiàn)本研究設(shè)計的氣管套管固定帶能顯著減輕患者皮膚損害發(fā)生率、顯著提高患者佩戴舒適度;護理人員更換改良固定帶較為容易,耗時較短,且被污染時,可清潔、消毒,從而減少更換次數(shù),減輕護理人員工作量,降低患者痛苦;喉墊更換較容易,且用時較短;套管脫出風險較低,更適用于氣管切開患者,值得臨床推廣、應(yīng)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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R472

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