网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
ICU专科护士主导的早期肺康复方案在机械通气AECOPD患者中的应用效果分析
作者:杨艳  夏广惠  荣芸 
单位:南京市胸科医院, 江苏 南京 210029
关键词:ICU专科护士 早期肺康复 急性发作期慢性阻塞性肺疾病 机械通气 
分类号:R473
出版年·卷·期(页码):2021·49·第二期(186-192)
摘要:

目的:探讨ICU专科护士在急性发作期慢性阻塞性肺疾病(AECOPD)患者行机械通气治疗中实施早期肺康复训练的效果。方法:选取收治于南京市胸科医院ICU 2018年1月至12月期间的AECOPD行机械通气治疗的患者30例作为对照组,采用常规护理;选取收治于本院ICU于2019年1月至12月的AECOPD行机械通气患者30例作为试验组,由ICU专科护士实施进行早期肺康复训练,比较两组患者干预前后动脉血二氧化碳分压(PaCO2)、氧合指数,比较两组患者相关并发症的发生率、机械通气时间、ICU入住时间及好转率等结局指标。结果:干预后的试验组血气分析中的PaCO2为(41.05±1.00) mmHg,明显低于干预后的对照组PaCO2[(46.16±1.03)]mmHg,干预后试验组的氧合指数(191.10±7.29),明显高于干预后对照组的氧合指数(167.73±10.27),差异均有统计学意义(P<0.05);试验组的呼吸机相关性肺炎(VAP)发生率、24 h再插管率、ICU谵妄发生率、下肢深静脉血栓(DVT)发生率、压疮发生率均低于对照组,差异有统计学意义(P<0.05);试验组的机械通气时间、ICU入住时间均低于对照组,差异有统计学意义(P<0.05);试验组的治愈好转率为80%,高于对照组53.3%,差异有统计学意义(P<0.05)。结论:ICU专科护士实施早期肺康复训练对降低呼吸机相关性肺炎、再插管率、ICU谵妄发生率、下肢DVT发生率、压疮发生率均有改善,同时还能缩短ICU入住时间及机械通气时间,提升患者治愈好转率,改善临床结局。

Objective:To explore the effect of ICU clinical nurses specialist implementing early lung rehabilitation training in mechanical ventilation treatment of AECOPD patients.Methods: A total of 30 patients who were admitted to the ICU of our hospital from January to December 2018 under mechanical ventilation treatment were defined as a control group, receiving routine care; A total of 30 patients admitted to the ICU of our hospital from January to December 2019 and performed with AECOPD mechanical ventilation were as allocated into a experimental group, and ICU clinical specialist nurses underwent early lung rehabilitation training. The PaCO2 and oxygenation index were compared before and after intervention in the two groups. The incidence of related complications and the time of mechanical ventilation, ICU length of stay, cure rate and other outcome indicators were compared in the two groups of patients. Results:PaCO2 in the blood gas analysis was (41.05±1.00) in the experimental group after intervention, which was significantly lower than that of the control group after intervention (46.16±1.03), and the oxygenation index of the experimental group after intervention (191.10±7.29) was significantly higher after intervention, the oxygenation index (167.73±10.27) of the control group was statistically significant (P<0.05); the incidence of VAP, the incidence of reintubation at 24 hours, the incidence of delirium in ICU, the incidence of DVT in the lower limbs and the incidence of pressure ulcers was lower than that of the control group, for which the difference was statistically significant (P<0.05); the mechanical ventilation time and ICU stay time of the experimental group were lower than these of the control group, the difference was statistically significant (P<0.05); the cure and improvement rate were counted as 80% in the experimental group, which was higher than the control group by 53.3%, with a statistically significant difference (P<0.05). Conclusion: The implementation of early lung rehabilitation training by ICU clinical nurse specialists can reduce the rate of ventilator-associated pneumonia, the incidence of reintubation, the incidence of ICU delirium, the incidence of lower limb DVT and the incidence of pressure ulcers, as well as it can also shorten ICU stay time and time of mechanical ventilation, which can improve the cure rate of patient and have better results in improving clinical outcomes.

参考文献:

[1] CORDOBA-LANUS E,CAZORLA-RIVERO S,EAPINOZA-JIMENEZ A,et al.Telomere shortortening and accelerated aging in COPD:Findings from the BODE cohort[J].Respir Res,2017,18(1):59.
[2] PIZZINI A,FILIPIAK W,WILLE J,et al.Analysis of volatile organic compounds in the breath of patients with stable or acute exacerbation of chronic obstructive pulmonary disease[J].J Breath Res,2018,12(3):036002.
[3] 慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组.慢性阻塞性肺疾病急性加重(AECOD)诊治中国专家共识(2017年更新版)[J].国际呼吸杂志,2017,37(14):1041-1057.
[4] SPRUIT M A,SINGH S J,GARVEY C,et al.An official American thoracic society/European respiratory society statement:key concepts and advances in pulmonary rehabilitation[J].Am J Respir Crit Care Med,2013,188(8):e13-e64.
[5] ZOUMOT Z,JORDAN S,HOPKINSON N S.Emphysema:time to say farewell to therapeutic nihilism[J].Thorax,2014,69(11):973-975.
[6] ROCHESTER C L,VOGIATZIS I,HOLLAND A E,et al.An official American thoracic society/European respiratory society policy statement:enhancing implementation,use,and delivery of pulmonary rehabilitation[J].Am J Respir Crit Care Med,2015,192(11):1373-1386.
[7] 中国康复医学会重症康复专业委员会呼吸重症康复学组.中国呼吸重症康复治疗技术专家共识[J].中国老年保健医学,2018,5(16):3-11.
[8] 中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[9] 詹梦梅,王建宁,周松,等.间歇声门下吸引预防ICU患者呼吸机相关性肺炎的Meta分析[J].中国护理管理,2018,18(2):206-213.
[10] LIANG G P,LIU T T,ZENG Y H,et al.Characteristics of subjects who failed a 120-minute spontaneous breathing trial[J].Respir Care,2018,63(4):388-394.
[11] KOKTURK N,GURGUN A,SEN E,et al.The view of the turkish thoracic society on the report of the GOLD 2017 global strategy for the diagnosis,management,and prevention of COPD[J].Turk Thorac J,2017,18(2):57-64.
[12] 王志威,黄怀.体外膈肌起搏器在脑卒中后肺康复中的应用进展[J].中华生物医学工程杂志,2017,23(1):350-351.
[13] 郭涛,童华生.心肺康复治疗在ICU获得性衰弱患者中的应用及效果观察[J].中国康复,2017,32(5):383-385.
[14] 顾君玲,朱晔,杨正宇,等.危重症专职护理小组对AECOPD呼吸衰竭患者血气指标与时效性的影响[J].护理实践与研究,2019,19(16):37-39.
[15] 潘文彦,张玉侠,李菁菁,等.以护士为主导的呼吸治疗肺康复团队的构建与运行[J].中国护理管理,2019,5(19):657-661.
[16] HASSAN Z M,WAHSHEH M A.Knowledge level of nurses in Jordan on ventilator-associated pneumonia and preventive measures[J].Nurs Crit Care,2017,22(3):125-132.
[17] WRIGHT S E,THOMAS K,WATSON G,et al.Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC):A multicentre,parallel-group,randomised controlled trial[J].Thorax,2018,73(3):213-221.
[18] MAGALHAES P A F,CAMILLO C A,LANGER D,et al.Weaning failure and respiratory muscle function:what has been done and what can be improved?[J].Respir Mde,2018,134:54-61.
[19] 安广浩,陈淼,詹文锋,等.电刺激膈神经逆转机械通气诱导膈肌功能不全影响的研究[J].中华结核和呼吸杂志,2018,41(2):111-115.
[20] 蒋玉兰,倪慧,谢立琴,等.机械通气期间早期康复活动应用于重度AECOPD病人的疗效分析[J].护理研究,2017,31(16):1994-1996.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 445989 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541