抽痰技術現況之探討

Current Issues of Suction Technique

「抽痰」是臨床上很常見的技術，尤其對於放置氣管內管、行氣切造口術及使用呼吸器病人而言，抽痰執行的頻率更高。不當的操作「抽痰」技術，可能造成病人上呼吸道傷害、感染與低血氧的危機，故「抽痰技術」在護理的養成教育中，是不可被忽視的一環。但綜觀國內外之護理技術指引，對於「抽痰技術」的執行步驟，多有不一致處，且缺乏充足的學理依據或文獻支持，故本文主旨在比較國、內外技術指引後，針對「滴入食鹽水抽痰的適當性」、「抽痰壓力的設定」「持續或間歇性抽吸」和「抽痰前後的給氧方式」等岐異較大且常被質疑的問題，進行文獻查證，結果顯示抽痰時滴入食鹽水方面，仍是蔽多於利，故不建議採用；抽痰壓力的設定以70～150mmHg最不易造成氣管黏膜的損傷且能達到抽吸分泌物的目的；採間歇或持續的抽痰方式尚無定論，仍待後續的研究來提供我們判斷的依據，現階段不論採用何方法，都應注意病人之狀況，儘量減少抽吸的次數，使傷害降到最低；在給氧方式上，過量充氣是較適合的給氧技術，且護理人員務必在抽痰過程中監測病人血壓的變化、動脈血氧值及心跳。

“Suction” is a common technique in clinical practice, especially for patient with endotracheal tube. Inappropriate performance of the suction technique can increase the risk of upper respiratory tract injury, infection, and hypoxemia. After reviewing the literature and textbooks, discrepancies were found in the suction procedures and routines. Some suggestions lacked of empirical evidence as well. The purpose of this article was to discuss the following discrepancies : (1) Whether nurse can instill normal saline while suction, (2) What is the proper pressure for suction, (3) Whether the continuous suction method is better than the intermittent suction method, and (4) What is the proper way of giving oxygenation while suction. The review demonstrated that it is inappropriate to instill normal saline while suction. Keeping the suction pressure in 70-150mmHg can avoid tracheal tissue damage and can remove the secretion effectively. Hyperinflation oxygenation method is recommended while suction. However, there is no empirical evidence to distinguish the performace quality of continuous and intermittent suction. More research is needed in this particular area.