综合护理干预在老年 COPD 稳定期患者中的应用

Application of comprehensive nursing intervention in stable-phase elderly patients with chronic obstructive pulmonary disease

目的：探讨综合护理干预在老年COPD稳定期患者中的应用效果。方法选择2009年10月-2011年9月收治的老年COPD患者82例作为对照组，选择2011年10月-2013年5月收治的老年COPD患者71例作为观察组，对照组患者给予常规护理，观察组在常规护理的基础上进行综合护理干预，主要包括健康教育、心理干预、营养指导、康复训练和跟踪指导。出院6月后，观察两组的血气分析、肺功能和生活质量情况。结果干预前两组患者血气分析、肺功能指标及生活质量各项评分比较差异均无统计学意义（P ＞0．05）；干预后，观察组患者 PaO2为（94．6±5．2） mmHg、PaCO2为（37．8±4．0）mmHg，对照组的分别为（87．5±4．8），（45．7±3．9）mmHg，观察组的血气分析改善优于对照组，两组，差异具有统计学意义（ t值分别为2．556，3．014；P＜0．05）；观察组患者的肺功能指标一秒用力呼气容积（FEV1）、用力肺活量（FVC）、最大肺活量（VCmax）、最大呼气流速峰值分别为（1．70±0．21）L、（2．49±0．31）L、（3．24±0．82）L和（4．56±1．83）％，对照组的分别为（1．63±0．20）L、（2．30±0．26）L、（2．89±0．80）L和（3．52±1．64）％，观察组患者的肺功能指标优于对照组，两组差异具有统计学意义（t值分别为2．173，2．355，2．965，3．284；P＜0．05）；观察组患者的日常生活、社会活动、抑郁和焦虑评分分别为（32．82±1．68），（16．59±1．84），（15．24±1．75），（15．69±2．21）分，对照组分别为（41．96±2．13），（22．59±2．42），（22．47±2．29），（22．86±2．32）分，观察组的生活质量指标改善均优于对照组，两组差异亦具有统计学意义（t值分别为3．526，3．278，3．360，3．297；P＜0．05）。结论综合护理干预对老年慢性阻塞性肺病稳定期患者的血气分析和肺功能改善均有积极意义，并能够显著提高患者的生活质量，值得在临床推广应用。

Objective To investigate the value of comprehensive nursing intervention in stable-phase elderly patients with chronic obstructive pulmonary disease .Methods From October 2011 to May 2013 , 71 cases with chronic obstructive pulmonary disease （ COPD） were chosen as the observation group , and another82 cases with chronic obstructive pulmonary disease （ COPD ） were chosen as the control group from October 2009 to September 2011 .The control group was treated with routine care , while the observation group was treated on the basis of comprehensive nursing intervention , including health education , psychological intervention , nutritional guidance , rehabilitation and tracking guidance .6 months after discharge , the results of blood tests pulmonary function and patients ’ quality of life were compared between groups .Results Before the intervention , the comparison of blood gas analysis , pulmonary function and patients ’ quality of life had no significant differences.After the intervention, for the observation group PaO2 was （94.6 ±5.2） mmHg and PaCO2 was （37.8 ±4.0）mmHg;for the control group PaO2 was （87.5 ±4.8）mmHg and PaCO2 was （45.7 ± 3.9） mmHg.The results of blood gas analysis were significantly improved in the observation group than the control group （t =2.556, 3.014, respectively;P 〈0.05）.The results of forced expiratory volume in one second （FEV1）, forced vital capacity （FVC）, maximal vital capacity （VCmax） and maximal peak expiratory flow rate were （1.70 ±0.21）L, （2.49 ±0.31）L, （3.24 ±0.82）L and （4.56 ±1.83）% in the observation group and （1.63 ±0.20）L, （2.30 ±0.26）L, （2.89 ±0.80）L and （3.52 ±1.64）% in the control group. The differences were statistically significant （t=2.173, 2.355, 2.965, 3.284, respectively; P〈0.05）.As for the observation group, the scores of daily life, social activity, depression and anxiety were （32.82 ±1.68）, （16.59 ±1.84）, （15.24 ±1.75） and （15.69 ±2.21）, respectively, which were significantly better than （41.96 ±2.13）, （22.59 ±2.42）, （22.47 ±2.29） and （22.86 ±2.32） in the control group （t=3.526, 3.278, 3.360, 3.297, respectively;P〈0.05）.Conclusions The comprehensive nursing intervention on the stable-phase elderly patients with chronic obstructive pulmonary disease have a positive meaning in the improvements of blood gas analysis and pulmonary function and it can significantly improve patients ’ quality of life, so it is worthy of clinical application .