摘要
目的:分析肺部超声指引下护士主导的胸肺物理治疗(CPT)在有创机械通气病人中的应用效果。方法:选取2021年6月—12月遵义市某三级医院重症医学科(ICU)收治的70例有创机械通气时间≥48 h的成人重症病人,按随机数字表法分为研究组和对照组。对照组采取常规CPT治疗;研究组根据肺部超声探查结果实施目标导向性CPT。观察两组干预前后肺部超声评分、呼吸功能、日排痰量、氧合指数(PaO2/FiO2)、有创机械通气相关并发症[呼吸机相关性肺炎(VAP)、肺不张、深静脉血栓(DVT)等]、转运不良事件发生率,记录两组干预后有创机械通气时间和ICU总住院时间。结果:剔除10例病人后,研究组纳入29例,对照组31例。两组干预后肺部超声评分都呈下降趋势,研究组在干预3~7 d较对照组更低(P<0.05)。两组干预后潮气量均升高,且研究组较对照组潮气量更高(P<0.05);两组干预后气道峰压较干预前均降低(P<0.05)。研究组日排痰量较对照组明显增多(P<0.05)。两组干预后氧合指数较干预前均有改善,且研究组在干预3~7 d较对照组升高(P<0.05)。研究组有创机械通气时间、ICU总住院时间、有创机械通气相关并发症和转运不良事件总发生率均低于对照组(P<0.05)。结论:实施肺部超声指引下护士主导的CPT治疗有助于有创机械通气病人清除下呼吸道分泌物,促进气道痰液排出,改善肺通气功能,减少有创机械通气相关并发症和转运不良事件的发生,缩短有创机械通气时间及入住ICU时间。
Objective:To analyze the application effect of nurse-led chest-lung physiotherapy(CPT)guided by lung ultrasound in patients with invasive mechanical ventilation.Method:A total of 70 adult critically ill patients with invasive mechanical ventilation time≥48 h admitted to the intensive care unit(ICU)of a tertiary grade A hospital in Zunyi from June to December 2021 were selected and divided into study group(29 cases)and control group(31 cases)according to the random number table method.The control group was treated with conventional CPT,the study group implemented target-oriented CPT according to the results of lung ultrasound exploration.The lung ultrasound score,respiratory function,daily sputum volume,oxygenation index(PaO2/FiO2),invasive mechanical ventilation-related complications(VAP,atelectasis,DVT)and the incidence of adverse transport events were observed before and after intervention in the two groups.The time of invasive mechanical ventilation and the total length of stay in ICU after intervention were recorded in the two groups.Results:After excluding 10 patients,29 patients were included in the study group and 31 patients were included in the control group.The lung ultrasound scores of the two groups showed a downward trend after intervention,and the study group was lower than the control group at 3-7 days of intervention(P<0.05).The tidal volume of the two groups increased after intervention,and the tidal volume of the study group was higher than that of the control group(P<0.05).The peak airway pressure of the two groups after intervention was lower than that before intervention(P<0.05).The daily sputum volume of the study group was significantly higher than that of the control group(P<0.05).The oxygenation index of the two groups after intervention was improved compared with that before intervention,and the study group was higher than the control group at 3-7days after intervention(P<0.05).The time of invasive mechanical ventilation,the total length of ICU stay,the total incidence of invasive mech
作者
杨娜娜
曾慧
周静
万洁
高飞
陈芳
陈德友
YANG Na′na;ZENG Hui;ZHOU Jing;WAN Jie;GAO Fei;CHEN Fang;CHEN Deyou(Zunyi Medical University,Guizhou 563000 China)
出处
《护理研究》
北大核心
2024年第9期1571-1577,共7页
Chinese Nursing Research
基金
贵州省卫生健康委科学技术基金项目,编号:gzwjkj2020-1-222
贵州省科技计划项目,编号:黔科合支撑〔2021〕一般043
遵义医科大学研究生科研基金项目,编号:ZYK181。
关键词
肺部超声
胸肺物理治疗
机械通气
护士主导
并发症
护理
lung ultrasound
chest physiotherapy
mechanical ventilation
nurse-led
complications
nursing
