胸外专科重症监护室过渡性护理对减少食管癌术后肺部感染的作用

Effect of transitional nursing on reducing postoperative pulmonary infection of esophageal cancer in thoracic surgery intensive care unit

目的回顾性分析食管癌术后胸外科专科重症监护室(ICU)过渡性护理对减少术后肺部感染的作用。方法根据食管癌术后患者是否进入胸外专科ICU接受过渡性护理,分为试验组和对照组。试验组术后转入胸外专科ICU观察治疗2~3 d再转回普通病房,在ICU期间除常规的食管癌术后护理外,重点加强气道管理。让患者转出ICU时能有效自主咳嗽、咳痰,呼吸道无痰储留,能自主或在陪护协助下下地活动。对照组则按食管癌术后护理常规护理。结果试验组和对照组在年龄、性别、BMI、吸烟指数、高血压史、糖尿病史、哮喘病史、第1秒用力呼气量占用力肺活量百分比(FEV1/FVC)的实测值与预计值比值、最大自主通气量占预测值百分比(MVV%)、食管肿瘤部位、手术术式、美国麻醉医师协会(ASA)分级、手术时间、术中出血量、术后呼吸机辅助呼吸、术后肿瘤TNM分期等可能影响肺部感染发生率的因素差异均无统计学意义(均P>0.05)。试验组术后经鼻/口吸痰管吸痰率高于对照组(66.67%vs 16.67%,P<0.001)。术后肺部感染发生率低于对照组(7.02%vs 27.08%,P<0.001)。术后住院时间少于对照组(13.75±2.21 d vs 16.40±2.79 d,P<0.001)。结论食管癌术后患者予胸外专科ICU过渡性护理,强化气道管理,可以有效降低肺部感染的发生率,有利于患者康复,减少术后住院时间。

Objective To retrospectively analyze the effect of transitional nursing on reducing postoperative pulmonary infection after esophageal cancer operation in thoracic surgery intensive care unit(ICU).Methods Patients with esophageal cancer were divided into experimental group and control group according to whether they entered the thoracic surgery ICU for transitional care after operation.The experimental group was transferred to the thoracic surgery ICU for observation and treatment for 2–3 days,and then returned to the general ward.During the ICU period,in addition to the routine postoperative care of esophageal cancer,it focused on strengthening airway management.When patients were transferred out of ICU,they could effectively cough and expectorate independently,had no sputum storage in the respiratory tract,and could walk independently or with the assistance.The control group received routine nursing according to the postoperative care of esophageal cancer.Results The age,gender,body mass index(BMI),smoking index,history of hypertension,history of diabetes,history of asthma,ratio of first second of expiratory volume/forced vital capacity(FEV1/FVC)to the predicted value,maximum voluntary ventilation percentage(MVV%),location of esophageal tumor,operative method,American Standards Association(ASA)grade,operative time,ventilatorassisted breathing,bleeding during operation and postoperative tumor TNM staging were compared between the experimental group and the control group.There was no significant difference in the factors that may affect the incidence of pulmonary infection(P>0.05).The rate of postoperative sputum suction through nasal or oral with sputum suction tube in the experimental group was higher than that in the control group(66.67%vs 16.67%,P<0.001).The incidence of postoperative pulmonary infection was lower than that in control group(7.02%vs 27.08%,P<0.001).The postoperative hospital stay was shorter than that in the control group(13.75±2.21 days vs 16.40±2.79 days,P<0.001).Conclusion After esophageal cancer surgery,transitional nursing in thoracic surgery ICU and strengthening airway management can effectively reduce the incidence of pulmonary infection,which is advantageous to the recovery and can reduce postoperative hospital stay.