我国呼吸治疗师在新型冠状病毒肺炎患者救治中的作用

The role of respiratory therapists in the treatment of coronavirus disease 2019 patients in China

目的调查我国呼吸治疗师(RTs)参加新型冠状病毒肺炎(新冠肺炎)患者救治的临床实践情况,总结RTs参与重大传染疾病救治的经验和作用。方法采用自行设计的问卷对我国31个省、市、自治区参与新冠肺炎患者救治工作的RTs进行调查。调查内容包括RTs基本工作情况、新冠肺炎患者救治具体工作以及工作中存在的问题。结果共发放问卷126份,回收有效问卷40份。40名RTs分布于全国8个省和直辖市的22家新冠肺炎定点收治医院,其中包括疫情核心区域武汉市7家医院。在各自的医疗团队中,RTs占医务人员的中位比例为2.9%(1.5%,6.7%),RTs工作年限约(6.2±5.4)年,RTs床位比约1∶11(1∶5,1∶26),85.0%(34/40)的RTs由其他医院抽调支援。97.5%(39/40)的RTs会制定个体化呼吸支持治疗策略,而在这些团队中所有RTs均会参与医疗团队的评估和决策工作以及呼吸功能恶化的早期识别;所有RTs〔100%(40/40)〕会主动巡视患者呼吸状态、会增加医疗团队对患者呼吸功能监测的手段和频率、会实施规范氧疗、会预防呼吸机相关性肺损伤(VALI)、会规范管理人工气道;但其中不到50%的RTs开展了应力应变、跨肺压、呼气末二氧化碳分压(PetCO_(2))、呼气末肺容积、电阻抗成像(EIT)等呼吸功能监测;85%的RTs为自己的医疗团队开展过呼吸治疗相关培训教育和制定相关操作规范。90%以上的RTs主导完成了经鼻高流量氧疗(HFNC)、肺保护性机械通气、俯卧位通气、肺康复、气道管理、重症患者转运等多项呼吸治疗临床实践工作。结论在新冠肺炎患者救治过程中,RTs充分发挥了临床评估、决策、实践的专业作用和优势,但RTs人力短缺极端突出,这些实践经验为今后呼吸道传染病的救治工作提供了依据,有效推进了呼吸治疗专业在我国的发展。

Objective To investigate the clinical practice of Chinese respiratory therapists(RTs)participating in the treatment of coronavirus disease 2019(COVID-19)patients and summarize the experience and role of RTs in the treatment of pandemic infectious diseases.Methods A self-designed questionnaire was used to investigate the RTs who treated COVID-19 patients in 31 provinces,cities and autonomous regions in China.The survey questionnaire included the basic work of RTs,the specific work of the treatment for COVID-19 patients and problems encountered at work.Results A total of 126 questionnaires were issued and 40 valid questionnaires were collected from RTs who treated COVID-19 patients at 22 COVID-19 designated hospitals in 8 provinces and municipalities.This included 7 hospitals in Wuhan,the epicenter of the epidemic.In their medical team,RTs accounted for 2.9%(1.5%,6.7%)of medical staff,the working experience of the RTs was about(6.2±5.4)years,the ratio of RTs to beds was about 1∶11(1∶5,1∶26),and 85.0%(34/40)of RTs were transferred from other hospitals.97.5%(39/40)of RTs were involved in formulating individual respiratory care strategies in their medical teams,and they were all involved in the evaluation of respiratory care and decision-making as well as the early identification of deterioration of respiratory function.All RTs[100%(40/40)]indicated that they would actively monitor patients'respiratory status,increase the means and frequency of the monitoring,implement standardized oxygen therapy,prevent ventilator-associated lung injury(VALI),and standardize the management of artificial airway.However,less than 50%of RTs had carried out stress and strain,transpulmonary pressure,partial pressure of end-tidal carbon dioxide(PetCO_(2)),end-expiratory lung volume,electrical impedance tomography(EIT)and other respiratory function monitoring.85%of RTs conducted training and education related to respiratory care and formulated relevant standard operating procedures for their medical teams.More than 90%of RTs led the implementation of high-flow nasal cannula oxygen therapy(HFNC),pulmonary protective mechanical ventilation,prone ventilation,pulmonary rehabilitation,airway management,transfer of critical patients,and other respiratory treatment.Conclusions RTs performed their professional role fully in the assessment,decision-making,and clinical practice in the treatment of COVID-19 patients.However,the manpower shortage of RTs is extremely prominent,the practical experience has provided the basis for the future treatment of infectious respiratory diseases and effectively promoted the development of respiratory care in China.