早期机械通气联合NICU专科护理对重型颅脑损伤并发急性呼吸窘迫综合征患者的影响

Effect of early ventilation combined comprehensive nursing intervention on patients with severe craniocerebral injury complicated with acute respiratory distress syndrome

目的探讨早期机械通气联合神经外科重症监护病房(NICU)专科护理干预对重型颅脑损伤并发急性呼吸窘迫综合征(ARDS)患者预后的影响。方法选取2016年2月~2018年2月我院NICU收治的重型颅脑损伤并发ARDS患者106例作为研究对象。根据机械通气情况分为及时机械通气组和延迟机械通气组,每组各53例。及时机械通气组在入院时确诊为重型颅脑损伤并发ARDS后立即进行机械通气,并给予NICU专科护理措施,延迟机械通气组在入院前已确诊为重型颅脑损伤并发ARDS或由于其他原因在合并ARDS 24小时后进行机械通气,给予相同的NICU专科护理措施。比较两组患者机械通气24h后动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)、撤机时间、格拉斯哥昏迷评分(GCS)及6个月后格拉斯哥预后评分(GOS)等指标变化情况。结果及时机械通气组机械通气后PaO2、SaO2指标均高于延迟机械通气组(P<0.05);及时机械通气组患者治疗后的GCS评分高于延迟机械通气组(P<0.05);及时机械通气组撤机时间短于延迟机械通气组(P<0.05);及时机械通气组GOS评分情况明显优于延迟机械通气组(P<0.05)。结论重型颅脑损伤并发ARDS的患者及早给予机械通气的同时进行积极正确的NICU专科护理干预,可明显缩短患者的机械通气时间,改善患者的昏迷程度,减少并发症发生,并改善预后,提高患者的生活质量,可在临床推广应用。

Objective To investigate the effect of early ventilation combined comprehensive nursing intervention on prognosis of patients with severe craniocerebral injury complicated with acute respiratory distress syndrome. Methods 106 patients with severe craniocerebral injury complicated with acute respiratory distress syndrome from February 2017 to February 2018 were selected as the subjects of the study. According to invasive mechanical ventilation, 106 patients were divided into timely invasive mechanical ventilation group(n=53) and delayed invasive mechanical ventilation group(n=53). The timely invasive mechanical ventilation group was mechanically ventilated immediately after they were admitted to the hospital after being diagnosed with severe craniocerebral injury complicated with acute respiratory distress syndrome, supplemented by appropriate comprehensive nursing interventions. The delayed invasive mechanical ventilation group was diagnosed with severe craniocerebral injury complicated with acute respiratory distress syndrome before admission to the hospital, or for other reasons, mechanical ventilation was performed after the combination of ARDS 24 h, supplemented by routine care. We compared the PaO2,PaCO2, SaO2, withdrawal time, Glasgow coma score(GCS) after mechanical ventilation 24 hours and Glasgow prognosis score(GOS) after 6 month between the two groups. Results The indicators of PaO2 and SaO2 were higher in the timely invasive ventilation group than those in the delayed invasive mechanical ventilation group, and the difference was statistically significant(P<0.05). The GCS score in the timely invasive mechanical ventilation group was higher than that of the delayed invasive mechanical ventilation group,which was statistically significant(P<0.05). The withdrawal time of patients in the timely invasive ventilation group was shorter than that of the delayed invasive mechanical ventilation group, and the difference was statistically significant(P<0.05).The results of GOS in patients with timely ventilation group were superior to that in patients with delayed mechanical ventilation group. The difference was statistically significant(P<0.05).Conclusion Active and correct comprehensive nursing interventioncombined with early ventilation in patients with severe brain injury complicated with acute respiratory distress syndrome can effectively relieve symptoms of respiratory failure, restore brain function, and reduce complications. Those have important significance to improve the clinical treatment effect, improve the prognosis and improve the life quality of patients.