个性化护理对ICU重症肺炎患者影响的研究

Effects of individualized nursing care in patients with severe pneumonia in ICU

目的探究个性化护理对重症加强护理病房(ICU)重症肺炎患者生存及生活质量、感染、心理状况和满意度等影响。方法选取2017年1月至2018年1月在浙江医院ICU病房收治的100例重症肺炎患者,分为常规护理组和个性化护理组,每组50例。常规护理组患者行临床常规护理模式干预,个性化护理组在常规护理的基础上行个性化护理模式干预。评价患者临床指标、急性生理及慢性健康(APACHEⅡ)评分、生活质量、心理负性情绪、多重耐药菌(multidrug-resistant organism,MDRO)感染发生率、呼吸机相关肺炎发生率、感染性休克发生率、病死率及患者对护理的满意度,并作组间比较。结果个性化护理组患者体温恢复正常时间(6.14±0.98)d、白细胞(white blood cell,WBC)计数恢复正常时间(7.21±0.50)d、机械通气时间(7.50±1.01)d、ICU住院时间(22.52±2.49)d均短于常规护理组(9.57±1.54、12.47±1.04、11.27±2.49和31.98±4.57)d(P均<0.05)。护理后个性化护理组APACHEⅡ评分(3.52±0.30)分、心理负性情绪评分(6.14±0.24、6.00±0.10)分低于常规护理组(8.45±0.52、8.17±0.52、7.68±0.54)分,生活质量评分(88.59±5.68)分高于常规护理组(80.47±3.49)分(P均<0.05)。个性化护理组患者MDRO感染发生率(4.00%)、呼吸机相关肺炎发生率(2.00%)、感染性休克发生率(4.00%)、病死率(2.00%)均低于常规护理组(P均<0.05)。个性化护理组患者对护理的总满意度(96.00%)高于常规护理组(80.00%)(P<0.05)。结论个性化护理可促进ICU重症肺炎患者恢复,在一定程度上预防MDRO感染的发生,改善预后,使患者更满意。

Objective To explore the impact of personalized nursing care on survival,quality of life(QOL),infection,psychological emotion and satisfaction of patients with severe pneumonia in ICU.Methods From January 2017 to January 2018,100 patients with severe pneumonia admitted to the ICU of Zhejiang Hospital were enrolled and evenly divided into observation group and control group.Patients in the control group received routine nursing care,while those in the observation group received both routine and personalized nursing care.The clinical indicators,ApacheⅡscore,quality of life,negative psychological emotion,MDRO infection rate,ventilator-associated pneumonia rate,septic shock rate,mortality rate and patients′satisfaction with nursing were recorded,evaluated and compared between the two groups.Results In the observation group,it took an average of(6.14±0.98)days and(7.21±0.50)days for body temperature and WBC count being back to normal,which were significantly shorter compared to that in control group(9.57±1.54 and 12.47±1.04)days(P<0.05).Patients in the observation group were on mechanical ventilation and in ICU for average of 22.52±2.49 and 7.50±1.01 days,which were significantly shorter compared to that in control group(11.27±2.49 and 31.98±4.57)days(P<0.05).After the intervention,ApacheⅡscore and negative psychological emotion score were lower while the score of QOL was higher in the observation group than that in control group,(3.52±0.30 vs 8.45±0.52;6.14±0.24 vs 8.17±0.52,6.00±0.10 vs 7.68±0.54;88.59±5.68 vs 80.47±3.49),the differences were statistically significant(P<0.05).The MDRO infection rate,ventilator-associated pneumonia rate,septic shock rate and mortality in the observation group(4.00%,2.00%,4.00%,2.00%)were significantly lower than those in the control group(P<0.05),while the overall satisfaction rate was higher(96.00%vs 80.00%,P<0.05).Conclusions Personalized nursing care can expedite the recovery of severe pneumonia patients in ICU,prevent MDRO infection,improve the prognosis and increase the satisfaction of patients.