咳嗽重塑锻炼在颅颈交界区畸形患者术后气管插管护理中的应用

Effects of cough remodeling exercise in postoperative tracheal intubation nursing among patients with craniocervical junction malformation

目的探讨咳嗽重塑锻炼在颅颈交界区畸形术后气管插管患者护理中的应用效果。方法采用便利抽样法选取解放军总医院神经外科2015年1月—2016年12月收治的颅颈交界区畸形行后路颈1侧块-颈2椎弓根钉棒复位内固定术后带气管插管的40例患者作为对照组,采用传统呼吸锻炼方法;选取2017年1月—2019年12月收治的同类手术40例患者作为试验组,在传统呼吸锻炼基础上实施咳嗽重塑锻炼。比较两组患者的咳嗽力量、白卡试验及气管插管带管时间、平均住院日、拔管后24 h再插管率、气管切开率、肺部感染发生率等气道管理效果指标。结果干预后,试验组患者的咳嗽力量强度优于对照组,差异有统计学意义(Z=-2.158,P=0.031);试验组的白卡试验阳性率(82.5%,33/40)高于对照组(55.0%,22/40),差异有统计学意义(χ^(2)=7.040,P=0.008);试验组的气管插管带管时间中位数为18.25 h,短于对照组的43.00 h(Z=-2.728,P=0.006);试验组的平均住院时间短于对照组,差异有统计学意义(Z=-2.848,P=0.004)。两组患者的拔管后24 h再插管率、气管切开率、肺部感染发生率比较,差异无统计学意义(P>0.05)。结论咳嗽重塑锻炼可以增强颅颈交界区畸形患者的咳嗽力量,缩短气管插管带管时间及平均住院日,值得在临床推广使用。

Objective To explore the effects of cough remodeling exercise in postoperative tracheal intubation nursing among patients with craniocervical junction malformation.Methods From January 2015 to December 2016,convenience sampling was used to select 40 craniocervical junction malformation patients admitted to the Department of Neurosurgery of the Chinese People's Liberation Army General Hospital and treated with posterior cervical 1 side mass-cervical 2 pedicle screw reduction and internal fixation,and with tracheal intubation as the control group,using traditional breathing exercise.From January 2017 to December 2019,40 craniocervical junction malformation patients with posterior cervical 1 side mass-cervical 2 pedicle screw reduction and internal fixation and internal fixation,and with tracheal intubation were selected as the experimental group,implementing cough remodeling exercise on the basis of traditional breathing exercise.The cough strength,white card test and tracheal intubation time,average hospital stay,reintubation rate 24 hours after extubation,tracheotomy rate,lung infection rate and other airway management effect indexes were compared between the two groups of patients.Results After intervention,the cough strength of experimental group was greater than that of control group,and the difference was statistically significant(Z=-2.158,P=0.031).The white card test positive rate of experimental group(82.5%,33/40)was higher than that of control group(55.0%,22/40),and the difference was statistically significant(χ^(2)=7.040,P=0.008).The median time of intubation in experimental group was 18.25 h,which was shorter than 43.00 h in control group(Z=-2.728,P=0.006);the average hospital stay of experimental group was shorter than that of control group,and the differences were all statistically significant(Z=-2.848,P=0.004).There was no significant difference in the reintubation rate 24 hours after extubation,tracheotomy rate,and lung infection rate of the two groups of patients(P>0.05).Conclusions Cough remodeling exercise can enhance the cough strength of patients with craniocervical junction malformation,shorten the time of tracheal intubation and the average hospital stay,which is worthy of clinical application.