综合气道护理干预在重症肺炎患儿治疗中的应用价值

Application value of comprehensive airway nursing intervention in the treatment of children with severe pneumonia

目的探讨综合气道护理干预在重症肺炎患儿治疗中的应用价值。方法选择深圳市儿童医院呼吸科2016年1月至2017年12月期间收治的98例重症肺炎患儿为研究对象,根据随机数表法将其分为观察组和对照组各49例,两组均给予抗感染等治疗,其中对照组患儿给予常规护理干预,观察组患儿则在此基础上应用综合气道护理干预措施,干预时间为7 d。比较两组患儿治疗后症状体征缓解时间、机械通气时间、呼吸机相关性肺炎(VAP)发生率、住院时间等临床指标,以及血超敏C-反应蛋白(hs-CRP)、白细胞(WBC)计数水平。结果观察组患儿的体温、气促、咳嗽、肺部啰音恢复时间分别为(3.4±1.3)d、(2.6±0.8)d、(4.4±1.2)d、(5.6±1.8)d,均明显短于对照组的(5.1±1.5)d、(4.3±1.1)d、(6.5±1.6)d、(7.2±2.3)d,差异均有统计学意义(P<0.05);观察组患儿的机械通气时间、住院时间分别为(3.7±1.0)d、(12.1±3.3)d,均明显短于对照组的(3.7±1.0)d、(15.5±4.2)d,VAP发生率为6.1%,明显低于对照组的16.3%,差异均有统计学意义(P<0.05);干预后,观察组患儿的血WBC计数及hs-CRP水平分别为(11.2±1.8)×10^9/L、(12.3±2.2)mg/L,明显低于对照组的(13.3±2.1)×10^9/L、(14.8±3.4)mg/L,差异均有统计学意义(P<0.05)。结论在重症肺炎患儿的临床治疗中,应用综合气道护理干预措施可以有效缓解患儿的临床症状、体征,缩短病程及降低呼吸机相关性肺炎的发生风险。

Objective To explore the application value of comprehensive airway nursing intervention in the treatment of children with severe pneumonia. Methods Ninety-eight children with severe pneumonia, who admitted to Department of Respiration, Shenzhen Children’s Hospital from January 2016 to December 2017, were selected and divided into the control group and observation group according to random number table method, with 49 cases in each group.The two groups were all given anti-infection and other treatments. The control group was given routine nursing intervention, while the observation group was given comprehensive airway nursing intervention on this basis. The intervention time was 7 days. The symptoms and signs remission time, mechanical ventilation time, ventilator-associated pneumonia(VAP) rate, hospitalization time, changes of blood high-sensitivity C-reactive protein(hs-CRP) and white blood cell(WBC) count were observed. Results The recovery time of body temperature, shortness of breath, cough and lung rale in the observation group were(3.4±1.3) d,(2.6±0.8) d,(4.4±1.2) d,(5.6±1.8) d, respectively, which were significantly shorter than corresponding(5.1±1.5) d,(4.3±1.1) d,(6.5±1.6) d,(7.2±2.3) d in the control group(all P<0.05). The duration of mechanical ventilation and hospitalization in the observation group were(3.7 ± 1.0) d and(12.1 ± 3.3) d, which were significantly shorter than(3.7±1.0) d and(15.5±4.2) d in the control group, and the VAP rate was significantly lower than that in the control group(6.1% vs 16.3%, al P<0.05). After intervention, the WBC count and hs-CRP levels in the observation group were(11.2 ± 1.8)× 10^9/L and(12.3 ± 2.2) mg/L, which were significantly lower than corresponding(13.3±2.1)×10^9/L and(14.8±3.4) mg/L in the control group(all P<0.05). Conclusion In the clinical treatment of children with severe pneumonia, the application of comprehensive airway nursing intervention measures can effectively alleviate the clinical symptoms and signs of children, shorten the course of disease and reduce the risk of ventilator-associated pneumonia.