基于6h复苏目标理论的护理干预对脓毒症患者生活质量及各项功能的影响

Effect of nursing intervention based on 6-hour resuscitation goal theory on quality of life and various functions of sepsis patients

目的探讨基于6 h复苏目标理论的护理模式对脓毒症患者各项功能、生活质量的影响.方法选取2016年4月至2018年7月温州医科大学附属第二医院收治的脓毒症患者142例.以采用传统护理干预策略的71例患者为常规护理组;以在常规护理基础上实施基于6 h复苏目标理论护理的71例患者为6 h复苏目标组.比较两组患者干预前和干预6 h后氧合功能指标〔中心静脉血氧饱和度(ScvO2)、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)〕和循环功能指标〔中心静脉压(CVP)、平均动脉压(MAP)、心率(HR)〕以及肾功能指标〔尿量与血肌酐(SCr)〕的差异;同时记录两组患者干预1个月后存活率、治疗情况及生活质量水平改善情况.结果干预后,两组患者CVP、MAP、ScvO2、PaO2、PaO2/FiO2、尿量和生活质量评分均较干预前升高, HR、SCr均较干预前降低,且6 h复苏目标组的变化较常规护理组更显著〔CVP(cmH2O,1 cmH2O=0.098 kPa):11.89±2.94 比 7.33±2.37,MAP(mmHg,1 mmHg=0.133 kPa):84.11±6.13 比 66.15±5.27,HR(次 /min):89.05±6.00比102.41±5.86,ScvO2 :0.78±0.03比0.66±0.04,PaO2(mmHg):154.71±20.75比106.54±24.66, PaO2/FiO2(mmHg):364.13±38.47比331.21±33.26,尿量(mL/h):71.13±10.22比37.42±13.41,SCr(μmol/L):113.10±14.35比125.12±13.87,角色功能(分):87.82±4.52比71.28±4.92,认知功能(分):89.23±4.63比71.75±5.34,躯体功能(分):90.24±4.43比72.74±5.03,情绪功能(分):88.92±5.71比73.42±3.48,社会功能(分):94.31±2.71比75.21±4.83,均P<0.05〕;6 h复苏目标组干预1个月后存活率高于常规护理组〔69.01% (49/71)比42.25%(30/71),P<0.05〕,重症医学科(ICU)住院时间、机械通气时间较常规护理组显著缩短〔ICU住院时间(d):7.34±3.31比9.42±3.60,机械通气时间(d):3.52±0.84比5.83±0.85,均P<0.05〕.结论基于6 h复苏目标理论的护理干预应用于脓毒症效果显著,可明显改善患者氧合功能、肾功能及循环功能,提高存活率与生活质量.

Objective To explore the effect of nursing mode based on 6-hour resuscitation goal theory on various functions and quality of life of patients with sepsis.Methods One hundred and forty-two septic patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from April 2016 to July 2018 were enrolled.A total of 71 patients selected to use traditional nursing intervention strategy were assigned in the routine nursing group;in the 6-hour resuscitation target theory group,71 patients were given nursing care based on 6-hour resuscitation target theory on the basis of traditional routine nursing.The differences in oxygenation function indexes[central venous blood oxygen saturation(ScvO2),arterial partial pressure of oxygen(PaO2)and oxygenation index(PaO2/FiO2)],circulatory function indexes[central venous pressure(CVP),mean arterial pressure(MAP)and heart rate(HR)],renal function indexes[urine volume and serum creatinine(SCr)]before and after intervention for 6 hours were compared between the two groups of patients;at the same time,the survival rate,treatment status and life quality improvement of the two groups after 1 month of intervention were recorded.Results After 6 hours of intervention,CVP,MAP,ScvO2,PaO2,PaO2/FiO2,urine volume and quality of life scores of patients in the 6-hour resuscitation target theory group and the routine nursing group were all increased compared with those before intervention,while the HR and SCr levels were lower than those before the intervention,moreover,the changes above indexes in the 6-hour resuscitation target theory group were more significant than those in the routine nursing group[CVP(cmH2O,1 cmH2O=0.098 kPa):11.89±2.94 vs.7.33±2.37,MAP(mmHg,1 mmHg=0.133 kPa):84.11±6.13 vs.66.15±5.27,HR(bpm):89.05±6.00 vs.102.41±5.86,ScvO2:0.78±0.03 vs.0.66±0.04,PaO2(mmHg):154.71±20.75 vs.106.54±24.66,PaO2/FiO2(mmHg):364.13±38.47 vs.331.21±33.26,urine volume(mL/h):71.13±10.22 vs.37.42±13.41,SCr(μmol/L):113.10±14.35 vs.125.12±13.87,role function scores:87.82±4.52 vs.71.28±4.92,cognitive function scores:89.23±4.63 vs.71.75±5.34,body function scores:90.24±4.43 vs.72.74±5.03,emotional function scores:88.92±5.71 vs.73.42±3.48,social function scores:94.31±2.71 vs.75.21±4.83,all P<0.05].One month after intervention,the survival rate in the 6-hour resuscitation target theory group was higher than that in the routine nursing group[69.01%(49/71)vs.42.25%(30/71),P<0.05],compared with routine nursing group,stay time in intensive care unit(ICU)and mechanical ventilation time in the 6-hour resuscitation target theory group were significantly shortened[stay time in ICU(days):7.34±3.31 vs.9.42±3.60,mechanical ventilation time(days):3.52±0.84 vs.5.83±0.85,both P<0.05].Conclusion The application of nursing intervention based on 6-hour resuscitation target theory for patients with sepsis has very significant effects on promoting the patients'oxygenation,renal and circulatory functions,and improving their survival rate and quality of life.