重症急性呼吸窘迫综合征出院患者康复体验的质性研究

Influencing factors of rehabilitative experience of discharged patients with severe acute respiratory distress syndrome

目的深入了解重症急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)出院患者康复体验,为制定有效的康复计划提供依据。方法采用目的抽样方法,于2019年5月至11月对北京市某三级甲等医院呼吸重症监护室好转出院的12例重症ARDS患者进行半结构式访谈,应用扎根理论三级编码的方法进行资料分析。结果共提炼4个主题:疾病后遗症带来的康复困扰(治疗并发症导致对康复安全性的顾虑、身体机能减退导致康复类型受限);康复效果的不确定感;社会支持不当(家属过度保护、专业人员康复支持不足);创伤后成长(接受、适应、自我反应)。结论影响重症ARDS出院患者康复的消极和积极因素包括疾病因素、个体因素、家庭因素和创伤后成长。建立康复信心、良好心理调适、调动家属支持和利用互联网+技术,做好出院患者康复管理,是重症ARDS出院患者康复计划制订和实施的有效途径。

Objective To investigate the rehabilitation experience of discharged patients with severe acute respiratory distress syndrome(ARDS) so as to provide a basis for making an effective rehabilitation plan. Methods Objective sampling method was used to conduct semi-structured interviews with 12 patients with severe ARDS,who were discharged from respiratory intensive care unit of a general hospital in Beijing between May and November 2019. The acquired data were analysed using grounded theory three-level coding method. Results Four themes were extracted: rehabilitation disturbance caused by disease sequelae(concerning about rehabilitation safety due to complications experienced in the treatment,limitation of type of rehabilitation due to physical dysfunction),uncertainty about the effect of rehabilitation,improper social support(over-protection from family members and insufficient rehabilitation support from professionals),and post-traumatic growth(acceptance,adaption and self-reaction). Conclusions The positive and negative factors affecting the recovery of discharged ARDS patients include the disease,the patient himself,the family factors and post-traumatic growth. Enhanced rehabilitation confidence,good psychological adjustment,increased family support and strengthened rehabilitation management are effective for formulating and implementing a rehabilitation plan for discharged patients with severe ARDS.