Research On Effect Of Different Positions On Sputum Suction In Patients With Severe Craniocerebral Injury After Tracheotomy

Objective: To investigate the effect of different position on sputum suction in the same condition on patients with severe craniocerebral injury after tracheotomy in order to choose the best suction position.Methods:(1)A total of 91 patients with severe craniocerebral injury after tracheotomy were enrolled in the Top three hospitals of Southern Anhui Province from June 2015 to December 2016.91 patients were randomly divided into three groups according to the order of admission time: group A(n = 29),group B(n = 32)and group C(n = 30).(2)Three groups of patients were taken the same airway humidification method,suction negative pressure,suction method and other neurosurgical routine care.All patients are taking on-demand suction method,if there are signs of suction,and timely to be sucked.(3)When the patients were sucked,patients in group A were taken the bed elevation 15 ° ~ 30 °,supine position and head to the side;patients in group B were taken the bed elevation 15 ° ~ 30 °,at the same time,the 45 °wedge was placed on the back of the patients and side 45 °;patients in group C were taken the bed elevation 15 ° ~ 30 °and side 90 °.(4)The pulse oxygen saturation,systolic blood pressure,diastolic blood pressure,heart rate,phlegm sounds,suction tolerance and airway mucosal injury were observed before and 3 min after suction on the first day,the fifth day and the seventh day after tracheotomy,then record the number of suction within 24 hours,and monitor the results of three days of sputum culture.The day of tracheotomy was the first day after tracheotomy,and the observation time was 7 days after tracheotomy.(5)The observation data were analyzed by SPSS18.0 software.P <0.05 was statistically significant.Results:(1)There was no significant difference among the three groups in general information such as sex,age,educational level and GCS score(P> 0.05).(2)There was no significant difference in pulse oxygen saturation,systolic blood pressure,diastolic blood pressure and heart rate before suction among the three groups on the first day,the fifth day and the seventh day after tracheotomy(P>0.05),and the difference was statistically significant at 3 min after suction(P <0.05).Compared with group A and group C,the pulse oxygen saturation of group B was higher than them,while systolic blood pressure,diastolic blood pressure and heart rate were lower than them(P <0.05),and there was no significant difference between group A and group C(P> 0.05).There was no statistically significant difference in suction tolerance among the three groups on the first day after tracheotomy(P> 0.05),but the difference was statistically significant on the fifth day and the seventh day after tracheotomy(P <0.05).Among three groups,patients in group B have better suction tolerance,group A followed,group C is poor.(4)The scores were significantly different among the three groups on the first day,the fifth day and the seventh day after tracheotomy(P <0.05).And there was significant difference among group A,group B and group C,group B was superior to group A and group C(P <0.05).There was no significant difference between group A and group C(P> 0.05).(5)There were significant differences in the total number of suction among three groups on the first day,the fifth day and the seventh day(P <0.05).Among three groups,patients in group B have less number of suction within 24 hours,group A followed,group C more(P <0.05).(6)There were significant differences in respiratory mucosal injury and sputum culture among three groups on the fifth day and the seventh day after tracheotomy(P <0.05),the positive rate of respiratory tract mucosal injury and sputum culture in group B was significantly lower than that in group A and C.Conclusion: When the bed was taken elevation15 ° ~30 °,compared to supine position and lateral 90 ° two position,lateral45 ° suction can completely remove the patient’s respiratory secretions,prolong the interval of suction,reduce the number of suction.The suction tube rarely have access to airway mucosa,smaller irritation,less damage,better effect of suction,thereby the respiratory mucosal injury and pulmonary infection rate decreased.