改良叩背法对肝胆外科住院患者肺部感染的预防控制效果

Effect of modified percussion-on-back method on prevention and control of pulmonary infections in hospitalized patients of hepatobiliary surgery department

目的探讨改良叩背法对肝胆外科住院患者肺部感染的预防控制效果,为降低肺部感染提供可靠方法。方法选取2011年1月-2015年12月医院肝胆外科患者5 000例,依据随机数表法平均分为观察组和对照组,分别进行改良叩背和传统叩背,记录干预前后两组患者24h排痰量、咳嗽困难程度,测定患者呼吸频率、SaO2、PaO2水平,并计算两组患者肺部感染发生率。结果干预前,两组患者24h排痰量及咳痰困难程度差异无统计学意义,干预后,观察组患者咳痰困难程度明显降低(1.15±0.13)分,24h排痰量显著升高(34.77±5.09)ml,与对照组[(1.73±0.18)分、(22.28±4.93)ml]比较差异有统计学意义(P<0.05);干预后,观察组患者呼吸频率(19.65±2.24)次/min明显低于对照组(23.06±2.58)次/min,SaO2(96.47±2.08)%、PaO2(76.18±2.93)mmHg明显高于对照组(92.63±2.14)%与(67.75±2.76)mmHg,差异有统计学意义(P<0.05);观察组肺部感染率为0.08%,低于对照组肺部感染率0.52%,差异有统计学意义(P<0.05)。结论改良叩背法能够明显增加住院肝胆外科患者排痰量,促进患者肺复张,降低肺部感染风险。

OBJECTIVE To explore the effect of modified percussion‐on‐back method on prevention and control of pulmonary infections in hospitalized patients of hepatobiliary surgery department so as to reduce the incidence of pulmonary infections .METHODS A total of 5 000 patients who were treated in the hepatobiliary surgery depart‐ment from Jan 2011 to Dec 2015 were enrolled in the study and randomly divided into the observation group and the control group ,which were respectively treated with the modified percussion‐on‐back method and the conven‐tional percussion‐on‐back method .The 24h expectoration volume and degree of difficulty in cough of the two groups of patients were recorded before and after the intervention;the respiratory rate and levels of SaO2 and PaO2 of the patients were determined;the incidence of pulmonary infection of the two groups of patients was cal‐culated .RESULTS There was no significant difference in the 24h expectoration volume or degree of difficulty in cough between the two groups of patients before the intervention .The degree of difficulty in cough of the observa‐tion group was remarkably decreased after the intervention（1 .15 ± 0 .13） points ,and the 24h expectoration volume was significantly increased （34 .77 ± 5 .09）ml ,as compared with the control group [（1 .73 ± 0 .18）points ,（22 .28 ± 4 .93）ml] ,and there was significant difference （P〈 0 .05） .The respiratory rate of the observation group was （19 .65 ± 2 .24）times/min after the intervention ,significantly lower than （23 .06 ± 2 .58）times/min of the control group;the SaO2 level of the observation group was （96 .47 ± 2 .08）% ,significantly higher than （92 .63 ± 2 .14）%of the control group;the PaO2 level of the observation group was （76 .18 ± 2 .93）mmHg ,significantly higher than （67 .75 ± 2 .76）mmHg of the control group （P〈0 .05） .The incidence of pulmonary infection of the observation group was 0 .08% ,lower than 0 .52% of the control group ,and there was significant difference （P〈 0 .05） . CONCLUSION The modified percussion‐on‐back method may contribute to the significant increase of expectora‐tion volume ,facilitate the lung recruitment ,and reduce the risk of pulmonary infection .