| Objective:1.Investigate and analyze the risk factors of substandard oxygen therapy effect in patients with Traumatic Brain Injury(TBI)during oxygen mask inhalation to provide a basis for improving patients’ oxygen therapy indexes.2.Find clinical targets for intervention from the analyzed risk factors,understand the problems existing in oxygen inhalation with traditional masks,and propose precise intervention with improved reinforced masks.3.Evaluate the intervention effect of improved reinforced masks combined with heated humidifiers in patients with TBI receiving oxygen after extubation.Methods:1.Retrospectively investigate and analyze the risk factors of substandard oxygen therapy effect in patients with TBI402 patients with TBI who received mask oxygen inhalation in ICU of two general hospitals in Jiangsu Province from December 2016 to February 2019 were selected as the study subjects.Access the critical care information management system and electronic case information system.Use the convenience sampling method to collect the risk factors of the substandard effect of oxygen therapy in patients with TBI.Univariate analysis and binary Logistic regression analysis were used to explore the independent risk factors for the substandard effect of oxygen therapy in patients with TBI.2.Explore the application effect of improved reinforced masks combined with heated humidifiers in patients with TBI receiving oxygen after extubationA total of 99 patients with TBI who were intubated and successfully decannulated in ICU of a tertiary hospital in Jiangsu Province from March 2021 to December 2022 were conveniently selected.According to the principle of randomization,the subjects were divided into control group(ordinary oxygen mask group),experimental group A(improved reinforced mask group)and experimental group B(improved reinforced mask combined with heated humidifier group),with 33 people in each group.After the tracheal intubation was removed,the corresponding oxygen inhalation device was used for oxygen inhalation respectively.The mask displacement rate after 1 hour of oxygen inhalation,Arterial partial pressure of Oxygen(Pa O2),Arterial partial pressure of Carbon Dioxide(Pa CO2),Heart Rate(HR) and Breathing Rate(RR)before and after intervention were recorded.The incidence of pressure injury on the head and face skin after 3 days of oxygen inhalation,the temperature of oxygen inhalation after 1 hour of oxygen inhalation and the viscosity of sputum after 24 hours of oxygen inhalation were also recorded.Results:1.Analysis results of risk factors for substandard mask oxygen therapy in patients with TBIUnivariate analysis of clinical data on related factors affecting the effect of oxygen therapy in patients with TBI showed that,APACHEⅡ score,hypertension,pulmonary infection,use of sedative,use of analgesics,mask shift,Procalcitonin(PCT),White Blood Cell(WBC),Activated Partial Thromboplastin Time(APTT)were significantly different(P<0.05).Binary Logistic regression analysis was performed on the statistically significant factors screened from univariate analysis.The results showed that hypertension,use of sedative drugs,use of analgesics,mask shift,PCT and WBC levels were independent risk factors affecting the effect of oxygen therapy in patients with TBI.2.Application study of improved reinforced masks combined with heated humidifiers in patients with TBI receiving oxygen after extubation(1)Before intervention,the gender,age,Glasgow Coma Scale(GCS),Body Mass Index(BMI),APACHE Ⅱ score,WBC count,PCT,occupation,education level,marital status,hypertension history,diabetes history,smoking history,Pa O2,Pa CO2,HR,RR of the three groups of patients were compared.The results showed that there was no statistical difference(P>0.05).(2)After the tracheal intubation was pulled out and oxygen was inhaled for 1 hour,there was a statistical difference in the mask displacement rate of the patients in the three groups(P<0.05).The mask displacement rate of the patients in experimental group A and experimental group B was lower than the control group.(3)After receiving different interventions,Pa O2 of patients in the three groups was statistically different(P<0.05).Pa O2 of patients in experimental group A and experimental group B was higher than that in the control group.Pa O2 of patients in experimental group B was higher than that in experimental group A.At the same time,HR of patients in the three groups was compared,with a statistically significant difference(P<0.05).HR of patients in the control group was faster than that of patients in experimental group A and experimental group B.Pa CO2 and RR of patients in each group after intervention were compared and there was no statistical difference among patients in the three groups(P>0.05).(4)In terms of intra group comparison,compared with oxygen inhalation in the airway before extubation,Pa O2 in the three groups of patients decreased after 1 hour of mask oxygen inhalation,with a statistically significant difference(P<0.05).Pa CO2 did not change significantly,with no statistically significant difference(P>0.05).RR was faster than before the intervention,with a statistically significant difference(P<0.05).HR of patients in the control group and experimental group A was faster than before the intervention,with a statistically significant difference(P<0.05).However,HR in experimental group B had no significant change compared with that before intervention,and the difference was not statistically significant(P>0.05).(5)After 3 days of mask oxygen inhalation,it was found that there was a statistical difference in the incidence of head and face skin pressure injury among the three groups(P<0.05).The incidence of skin pressure injury in experimental group A and experimental group B was lower than that in the control group.In terms of the degree of injury,there was a statistical difference in the degree of skin pressure injury among the three groups of patients(P<0.05).As far as the injury site is concerned,only 6 cases of auricle skin pressure injury and 1 case of mandibular skin pressure injury occurred in the control group.(6)After intervention,it was also found that the oxygen temperature inside the mask of patients in the three groups was statistically different(P<0.001).The oxygen inhalation temperature of patients in the control group and experimental group A was lower than that of patients in experimental group B.(7)After 24 hours of oxygen inhalation by mask,there was a statistical difference in the average level of sputum viscosity among the three groups of patients(P<0.05).The sputum viscosity of patients in experimental group B was better than that of patients in control group and experimental group A.(8)The length of ICU stay of the three groups was statistically different(P < 0.05),and the length of ICU stay of experimental group A and experimental group B was shorter than that of control group.Conclusions:1.The effect of oxygen therapy may not reach the standard in patients with TBI during mask oxygen inhalation.The factors affecting the effect of oxygen therapy were analyzed and it was found that APACHEⅡ score,hypertension,pulmonary infection,use of sedative drugs,use of analgesics,mask shift,PCT,WBC and APTT all affected the effect of oxygen therapy.Hypertension,use of sedatives,use of analgesics,mask shift,PCT and WBC levels are independent risk factors affecting the effect of oxygen therapy.Clinical medical staff should pay attention to the risk factors that affect the effect of patients’ oxygen inhalation.In particular,targeted intervention should be carried out on factors under human control.2.Improved reinforced mask bases on independent risk factors affecting the effect of oxygen therapy.For the important angle of mask displacement,we strengthen the fixation of patients’ oxygen masks,improve the effectiveness of oxygen inhalation,improve the effect of oxygen therapy and shorten the length of ICU stay.At the same time,for patients with TBI who have just had endotracheal intubation removed,we introduce the use of heated humidifiers to optimize the viscosity of patients’ sputum,promote patients’ sputum excretion and further enhance the efficacy of patients’ oxygen inhalation.Therefore,the application of improved reinforced masks combined with heated humidifiers is the optimal scheme for patients with TBI receiving oxygen after extubation. |
PDF Full Text Request