急性呼吸衰竭无创正压通气治疗前简易呼吸器预处理循证实践

Evidence-based practice of simple respirator pretreatment before non-invasive positive pressure ventilation in acute respiratory failure

目的:将循证护理理念应用于急性呼吸衰竭患者无创正压通气(NIPPV)治疗前先行使用简易呼吸器进行预处理的措施中,并观察临床实践结果。方法:选取2017年1月至2019年5月本院急诊科接诊的急性呼吸衰竭患者46例,随机分为对照组(n=22)和观察组(n=24)。对照组接受常规处理后执行NIPPV治疗模式,观察组在接受NIPPV治疗前,先行使用简易呼吸器进行护理干预。对比两组NIPPV口鼻罩首次佩戴耐受情况及24h内呼吸功能包括心率(HR)、呼吸频率(R)、氧分压(PaO 2)和二氧化碳分压(PaCO 2)改善情况,以及治疗24h后呼吸机相关并发症发生率。结果:干预前,两组HR、R、PaO 2和PaCO 2比较无明显差异(P>0.05);观察组口鼻罩初次佩戴耐受时间明显长于对照组;干预后,NIPPV治疗24h内两组指标对比干预前均有明显改善,但观察组改善幅度又明显优于对照组;观察组治疗NIPPV 24h后呼吸机并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:急性呼吸衰竭患者行NIPPV治疗前先行简易呼吸器预处理干预,可明显改善患者耐受情况,有效缓解人机对抗情况,减少并发症,提高急诊救治成功率。

Objective:The evidence-based nursing concept was applied to the treatment of non-invasive positive pressure ventilation(NIPPV)in patients with acute respiratory failure before the treatment with a simple respirator,and the clinical practice results were observed.Methods:Forty-six patients with acute respiratory failure who were admitted to the emergency department of our hospital from January 2017 to May 2019 were randomly divided into control group(n=22)and observation group(n=24).The control group underwent routine treatment and then performed the NIPPV treatment mode.The observation group was treated with a simple respirator before the NIPPV treatment.Compare the first-time wearing tolerance of the two groups of NIPPV nasal masks and the respiratory function within 24 hours including improvement of heart rate(HR),respiratory rate(R),partial pressure of oxygen(PaO 2)and partial pressure of carbon dioxide(PaCO 2),and breathing after 24 hours of treatment.Machine-related complication rate.Results:Before intervention,there was no significant difference in HR,R,PaO 2 and PaCO 2 between the two groups(P>0.05).The initial wear tolerance time of the nasal mask in the observation group was significantly longer than that in the control group.After intervention,the two groups of indicators within 24 hours after NIPPV treatment were compared before intervention.There was significant improvement,but the improvement rate of the observation group was significantly better than that of the control group.The incidence of ventilator complications in the observation group was significantly lower than that of the control group after 24 hours of NIPPV treatment(P<0.05).Conclusion:Patients with acute respiratory failure undergoing simple respirator pretreatment before NIPPV treatment can significantly improve patient tolerance,effectively alleviate human-machine confrontation,reduce complications,and improve the success rate of emergency treatment.