改良床旁肺部超声评估方案在重症肺炎机械通气患者胸部物理治疗中的应用

The application of beside lung ultrasound in emergency-plus protocol for chest physical therapy in patients with severe pneumonia

目的探讨改良床旁肺部超声评估(BLUE)方案在重症肺炎机械通气患者中的应用效果。方法将100例入住ICU的机械通气患者按照入住时间分为对照组和试验组,每组50例。对照组按照常规影像资料及肺部听诊给予胸部物理治疗,试验组在常规影像资料及肺部听诊基础上,每日按照改良BLUE方案进行肺部超声评估后给予胸部物理治疗。观察2组患者的机械通气时间、ICU住院时间及治疗后1、2、4、7 d自主排痰能力。结果试验组机械通气时间(7.82±1.38)d、ICU住院时间(10.16±1.88)d,对照组患者机械通气时间(10.14±1.73)d,ICU住院时间(12.78±2.11)d,2组比较差异有统计学意义(t=7.42、6.56,均P<0.05);2组治疗后4、7 d自主排痰能力比较差异有统计学意义(Z=-2.47、-2.52,均P<0.05);2组治疗后1、2 d自主排痰能力比较差异无统计学意义(P>0.05)。结论肺部超声可连续监测肺部变化,护士可以根据超声图像,对患者实施目标导向性胸部物理治疗。

Objective To explore the effect of chest physical therapy guided by ultrasound in patients with severe pneumonia.Methods One hundred patients with mechanical ventilation in the ICU were divided into a control group and a test group according to the occupancy time.The control group was given chest physical therapy according to routine imaging data and pulmonary auscultation.The experimental group was given physical therapy of the chest according to the routine imaging and pulmonary auscultation,also according to the BLUE ultrasound protocol.The mechanical ventilation time,ICU hospitalization time and the drainage capacity of 1 day,2 days,4 days,and 7 days after treatment were observed.Results The mechanical ventilation time was(7.82±1.38)days and ICU hospitalization time were(10.16±1.88)days in the test group.The mechanical ventilation time was(10.14±1.73)days and ICU hospitalization time were(12.78±2.11)days in the control group.There were significant differences between the two groups(t=7.42,6.56,P<0.05).There was a significant difference in the ability of spontaneous drainage on the 4th and 7th day after treatment between the two groups(Z=-2.47,-2.52,P<0.05).The sputum ability on the first and second day after treatment were not statistically significant between the two groups(P>0.05).Conclusions Pulmonary ultrasound can continuously monitor lung changes.Nurses can perform targeted nursing treatment on the basis of ultrasound.