置放氣管內管病人使用密閉式抽痰或開放式抽痰對生理參數、環境菌落數及疼痛之成效探討

使用氣管內管的病人，經常在抽痰過程中產生不良反應，影響生命徵象及造成相關合併症。本文旨在探討置放氣管內管合併使用呼吸器病人，執行開放式或密閉式抽痰對生理參數、環境菌落數及疼痛之影響。本研究於北部某區域教學醫院進行，採隨機分派共收案108人，分爲對照組（開放式抽痰）52人，及實驗組（密閉式抽痰）56人，以生理參數、Clean-Trace ATP菌落監測及中文版重症照護疼痛觀察工具，作爲成效指標。結果顯示抽痰後立即之氧氣飽和濃度及疼痛（P = .00）達統計差異，顯示使用密閉式抽痰其氧氣飽和濃度穩定，且抽痰時病人疼痛指數較低；而兩組之心跳（HR）、收縮壓（SBP）、舒張壓（DBP）及平均動脈壓（MBP）及環境菌落數則無顯著差異（P＞ .05）。由研究結果得知，使用密閉式抽痰系統可避免病人抽痰時氧飽和濃度下降，且抽痰引起之疼痛狀況亦較輕。建議使用氣管內管合併使用呼吸器之病人，執行抽痰時，應採用密閉式抽痰。

關鍵字

密閉式抽痰；生理參數；環境菌落數；疼痛

並列摘要

Endotracheal suctioning is one of the most common invasive procedures carried out in intubated patients which affects vital signs and causes adverse effects. The aim of this study was to investigate the effects of open and closed endotracheal suctioning methods particularly that of pain, physiological parameters and environmental colonies in mechanically ventilated patients. The study was conducted in a regional hospital located in northern Taiwan, in which a total of 108 qualified participants were randomly assigned into a control group with open suction systems (n = 52) and an experimental group with closed suction systems (n = 56). The physiological parameters, the Clean-Trace ATP Colony Surveillance and the Critical-Care Pain Observation Tool (Chinese edition) acted as performance indicators during this study. The results of the study showed statistical differences in oxygen saturation concentration and pain (P = .00), which indicated that the closed suctioning system allowed for stabilization of oxygen concentration and minimized pain for patients. There were no significant differences in the mean values of heart rate, SBP, DBP, MAP, and number of environmental colonies in the patients who underwent endotracheal suction with the open and closed suction systems (P ＞ .05). The findings of this study show that closed endotracheal suctioning leads to an increase of oxygen saturation and a decrease in pain levels in mechanically ventilated patients. Overall, it is highly recommended that the closed suctioning method be utilized in mechanically ventilated patients whenever possible.

並列關鍵字

closed suction system ； physiological parameters ； number of environmental colonies ； pain

參考文獻

Raziyeh, D., Abbas, E., & Amir, V. A.,( 2016). Comparison of the Effect of Open and Closed Endotracheal Suctioning Methods on Pain and Agitation in Medical ICU Patients: A Clinical Trial. Anesth Pain Med, 6(5), e38337.

李薇莉、梁天麗、陳夏蓮(2010).成人加護病房內護理人員對氣管內抽吸術認知程度之探討,弘光學報,58,13-29