ICU专科护士主导的早期肺康复方案在机械通气AECOPD患者中的应用效果分析

Application of early pulmonary rehabilitation training implemented by ICU specialist nurses in mechanical ventilation treatment of AECOPD patients

目的:探讨ICU专科护士在急性发作期慢性阻塞性肺疾病(AECOPD)患者行机械通气治疗中实施早期肺康复训练的效果。方法:选取收治于南京市胸科医院ICU 2018年1月至12月期间的AECOPD行机械通气治疗的患者30例作为对照组,采用常规护理;选取收治于本院ICU于2019年1月至12月的AECOPD行机械通气患者30例作为试验组,由ICU专科护士实施进行早期肺康复训练,比较两组患者干预前后动脉血二氧化碳分压(Pa CO_(2))、氧合指数,比较两组患者相关并发症的发生率、机械通气时间、ICU入住时间及好转率等结局指标。结果:干预后的试验组血气分析中的Pa CO_(2)为(41.05±1.00)mm Hg,明显低于干预后的对照组Pa CO_(2)[(46.16±1.03)]mm Hg,干预后试验组的氧合指数(191.10±7.29),明显高于干预后对照组的氧合指数(167.73±10.27),差异均有统计学意义(P<0.05);试验组的呼吸机相关性肺炎(VAP)发生率、24 h再插管率、ICU谵妄发生率、下肢深静脉血栓(DVT)发生率、压疮发生率均低于对照组,差异有统计学意义(P<0.05);试验组的机械通气时间、ICU入住时间均低于对照组,差异有统计学意义(P<0.05);试验组的治愈好转率为80%,高于对照组53.3%,差异有统计学意义(P<0.05)。结论:ICU专科护士实施早期肺康复训练对降低呼吸机相关性肺炎、再插管率、ICU谵妄发生率、下肢DVT发生率、压疮发生率均有改善,同时还能缩短ICU入住时间及机械通气时间,提升患者治愈好转率,改善临床结局。

Objective:To explore the effect of ICU clinical nurses specialist implementing early lung rehabilitation training in mechanical ventilation treatment of AECOPD patients.Methods:A total of 30 patients who were admitted to the ICU of our hospital from January to December 2018 under mechanical ventilation treatment were defined as a control group,receiving routine care;A total of 30 patients admitted to the ICU of our hospital from January to December 2019 and performed with AECOPD mechanical ventilation were as allocated into a experimental group,and ICU clinical specialist nurses underwent early lung rehabilitation training.The Pa CO_(2) andoxygenation index were compared before and after intervention in the two groups.The incidence of related complications and the time of mechanical ventilation,ICU length of stay,cure rate and other outcome indicators were compared in the two groups of patients.Results:Pa CO_(2) in the blood gas analysis was(41.05±1.00)in the experimental group after intervention,which was significantly lower than that of the control group after intervention(46.16±1.03),and the oxygenation index of the experimental group after intervention(191.10±7.29)was significantly higher after intervention,the oxygenation index(167.73±10.27)of the control group was statistically significant(P<0.05);the incidence of VAP,the incidence of reintubation at 24 hours,the incidence of delirium in ICU,the incidence of DVT in the lower limbs and the incidence of pressure ulcers was lower than that of the control group,for which the difference was statistically significant(P<0.05);the mechanical ventilation time and ICU stay time of the experimental group were lower than these of the control group,the difference was statistically significant(P<0.05);the cure and improvement rate were counted as 80%in the experimental group,which was higher than the control group by 53.3%,with a statistically significant difference(P<0.05).Conclusion:The implementation of early lung rehabilitation training by ICU clinical nurse specialists can reduce the rate of ventilator-associated pneumonia,the incidence of reintubation,the incidence of ICU delirium,the incidence of lower limb DVT and the incidence of pressure ulcers,as well as it can also shorten ICU stay time and time of mechanical ventilation,which can improve the cure rate of patient and have better results in improving clinical outcomes.