自制防二氧化碳潴留雾化器应用于COPD并呼吸衰竭患者中的循证实践

Evidence-based application of self-made anti-carbon dioxide retention atomizer in patients with chronic obstructive pulmonary disease and respiratory failure

目的将循证护理概念应用于慢性阻塞性肺疾病(COPD)并呼吸衰竭患者吸入性治疗的实践中,介绍自制防二氧化碳潴留雾化器的使用方法,并观察使用效果。方法选择2018年5月至2019年4月河北医科大学附属哈励逊国际和平医院呼吸科收治的COPD并呼吸衰竭患者,所有患者均在抗感染、解痉等治疗的同时接受雾化吸入性治疗。以使用自制防二氧化碳潴留雾化器为时间节点,前瞻性选择2018年11月至2019年4月使用自制防二氧化碳潴留雾化器进行吸入性治疗的40例患者作为观察组,通过循证护理策略,检索国内外相关文献,查找临床证据,制定并实施护理方案;回顾性分析2018年5月至10月使用普通面罩雾化器进行吸入性治疗的40例患者作为对照组。比较两组患者雾化吸入前5 min和雾化吸入20 min时的外周动脉血气分析指标〔pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)〕以及肺部哮鸣音消失和患者配合治疗情况。结果所有患者均纳入最终分析。两组雾化吸入前动脉血气分析指标差异均无统计学意义。雾化吸入20 min,两组患者pH值、PaO2、PaCO2均得到改善,且观察组较对照组改善更为明显〔pH值:7.32±0.35比7.25±1.25,PaO2(mmHg,1 mmHg=0.133 kPa):61.50±1.55比59.50±1.05,PaCO2(mmHg):43.25±1.65比49.05±1.75,均P<0.05〕。两组患者雾化吸入20 min肺部哮鸣音均较雾化前明显改善,且观察组肺部哮鸣音改善明显优于对照组〔哮鸣音评分(分):0.91±0.29比1.65±0.35,P<0.05〕。观察组患者配合良好率明显高于对照组〔90%(36/40)比70%(28/40),χ^2=3.828,P=0.048〕。结论与使用普通面罩雾化器进行吸入性治疗相比,应用自制防二氧化碳潴留雾化器雾化吸入治疗的COPD并呼吸衰竭患者可减少二氧化碳潴留,明显改善呼吸衰竭症状,并提高依从性。

Objective To apply the concept of evidence-based nursing in the practice of inhalation therapy for patients with chronic obstructive pulmonary disease(COPD)complicated respiratory failure,introduce the application method of self-made anti-carbon dioxide retention atomizer,and to observe the application effect.Methods Patients with COPD combine respiratory failure admitted to the respiratory department of Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to April 2019 were enrolled.All patients received atomization inhalation therapy in addition to anti-infection and spasmolysis.By using self-made carbon dioxide retention atomizer time node,40 patients in the prospective study using home-made carbon dioxide retention atomizer inhalation therapy from November 2018 to April 2019 were enrolled as observation group.Through evidence-based nursing strategy,the related literature at home and abroad was retrieved,to find the clinical evidence,formulation and implementation of care plan.Forty patients who received inhalation therapy with normal mask atomizer from May to October in 2018 were enrolled as the control group in the retrospective analysis.The peripheral arterial blood gas analysis indexes[pH value,arterial oxygen partial pressure(PaO2),arterial carbon dioxide partial pressure(PaCO2)],the disappearance of pulmonary asthma at 5 minutes before atomization inhalation and 20 minutes after atomization inhalation,and the patient's cooperation in treatment were compared between the two groups.Results All patients were included in the final analysis.There was no significant difference in blood gas analysis indexes between the two groups.After 20 minutes of atomization inhalation,the pH value,PaO2 and PaCO2 of the two groups were improved,and the improvement was more obvious in the observation group[pH value:7.32±0.35 vs.7.25±1.25,PaO2(mmHg,1 mmHg=0.133 kPa):61.50±1.55 vs.59.50±1.05,PaCO2(mmHg):43.25±1.65 vs.49.05±1.75,all P<0.05].The lung asthma in the two groups was significantly improved with 20 minutes of atomization inhalation as compared with that before atomization,and the improvement of lung asthma in the observation group was significantly better than that in the control group(asthma score:0.91±0.29 vs.1.65±0.35,P<0.05).The good coordination rate of the observation group was significantly higher than that of the control group[90%(36/40)vs.70%(28/40),χ^2=3.828,P=0.048].Conclusion Compared with the inhalation treatment with ordinary mask nebulizer,inhalation treatment with self-made anti-carbon dioxide retention atomizer for COPD patients with respiratory failure can reduce carbon dioxide retention,significantly improve respiratory failure symptoms and improve compliance.