过渡期护理联合抗阻呼吸训练在老年肥胖型阻塞性睡眠呼吸暂停低通气综合征中的应用效果

Effect of transitional nursing combined with resistance breathing training on elderly obese obstructive sleep apnea-hypopnea syndrome

目的分析过渡期护理(TCM)模式联合抗阻呼吸训练对老年肥胖型阻塞性睡眠呼吸暂停低通气综合征(OSAHS)呼吸中枢低氧反应性的影响。方法选取南京鼓楼医院老年科2018年1月至2020年12月收治的78例OSAHS患者为研究对象。按照随机数字表法将患者分为观察组和对照组各39例;对照组采用基础护理联合抗阻呼吸训练模式干预,观察组在对照组基础上采用TCM模式干预;护理干预前和出院后1个月时采用匹兹堡睡眠质量指数(PSQI)量表、生命质量量表(SF-36)、蒙特利尔认知功能测评量表(MoCA)对患者的睡眠质量、生命质量、认知功能进行评估;护理干预前和出院后1个月检测患者FVC、FEV_(1)、FEV_(1)/FVC。结果出院后1个月观察组患者PSQI白天功能紊乱、使用睡眠药物、习惯性睡眠效率、主观睡眠质量、睡眠紊乱、睡眠潜伏期、睡眠持续性和总分分别为(1.63±0.33)、(1.22±0.29)、(1.63±0.29)、(1.12±0.31)、(1.35±0.34)、(1.09±0.28)、(1.74±0.26)、(9.78±0.59)分,明显低于对照组的(2.27±0.34)、(2.03±0.31)、(2.09±0.23)、(1.85±0.28)、(2.11±0.28)、(1.40±0.24)、(2.12±0.41)、(13.87±0.56)分,差异有统计学意义(t值为4.91~31.61,均P<0.01);出院后1个月观察组患者SF-36中精神健康、躯体疼痛、生理功能、生理职能、情感职能、生命活力、社会功能和总体健康评分分别为(69.81±5.74)、(76.12±6.02)、(70.84±6.08)、(71.74±5.99)、(50.93±6.12)、(70.52±5.94)、(69.89±5.53)、(68.41±4.99)分,高于对照组的(62.83±6.31)、(68.94±5.91)、(61.99±5.98)、(64.85±6.13)、(43.28±5.74)、(64.85±6.12)、(61.21±5.74)、(62.31±6.85)分,差异有统计学意义(t值为4.18~7.77,均P<0.01);出院后1个月观察组患者MoCA中视空间与执行功能、注意、语言、延迟回忆、定向力、抽象和总分分别为(4.95±0.31)、(5.68±0.27)、(2.67±0.24)、(3.98±0.19)、(5.47±0.28)、(5.64±0.23)、(28.39±1.09)分,明显高于对照组的(4.48±0.37)、(5.23±0.29)、(2.43±0.27)、(3.37±0.31)、(5.01±0.33)、(5.27±0.26)、(25.79±1.17)分,差异有统计学意义(t值为4.17~10.51,均P<0.01);出院后1个月观察组患者FVC、FEV_(1)和FEV_(1)/FVC水平分别为(2.89±0.19)L、(1.99±0.17)L、(68.86±3.99)%,明显高于对照组的(2.59±0.18)L、(1.60±0.14)L、(61.78±4.01)%,差异有统计学意义(t=7.21、11.14、7.87,均P<0.05)。结论TCM模式联合抗阻呼吸训练对老年肥胖型OSAHS患者干预后可有效改善呼吸中枢低氧反应性。

Objective To analyze the effect of transitional care model(TCM)mode combined with resistance breathing training on hypoxic reactivity of respiratory center in elderly obese obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods Totally 78 patients with OSAHS who met the criteria were selected from the geriatric department of Nanjing Drum Tower Hospital from January 2018 to December 2020 and divided into observation group and control group by random digits table method,with 39 cases in each group;the control group was intervened by basic nursing combined with resistance breathing training mode,and the observation group was intervened by TCM mode on the basis of the control group.Before nursing and 1 month after discharge,Pittsburgh Sleep Quality Index(PSQI),Short-Form 36-item Health Survey(SF-36),Montreal Cognitive Assessment(MoCA)were used to evaluate the sleep quality,quality of life and cognitive function of the patients.Besides,FVC,FEV_(1),FEV_(1)/FVC were also tested before nursing and 1 month after discharge.Results One month after discharge,the daytime dysfunction,use of sleep drugs,habitual sleep efficiency,subjective sleep quality,sleep disorder,sleep latency,sleep duration and total score of PSQI in the observation group were significantly lower than those in the control group(the control group:2.27±0.34,2.03±0.31,2.09±0.23,1.85±0.28,2.11±0.28,1.40±0.24,2.12±0.41,13.87±0.56;the observation group:1.63±0.33,1.22±0.29,1.63±0.29,1.12±0.31,1.35±0.34,1.09±0.28,1.74±0.26,9.78±0.59)(t values were 4.91-31.61,all P<0.01).One month after discharge,the scores of mental health,physical pain,physiological function,physiological function,emotional function,life vitality,social function and overall health of SF-36 in the observation group were significantly higher than those in the control group(the control group:62.83±6.31,68.94±5.91,61.99±5.98,64.85±6.13,43.28±5.74,64.85±6.12,61.21±5.74,62.31±6.85;the observation group:69.81±5.74,76.12±6.02,70.84±6.08,71.74±5.99,50.93±6.12,70.52±5.94,69.89±5.53,68.41±4.99)(t values were 4.18-7.77,all P<0.01).One month after discharge,the scores of visual space and executive function,attention,language,delayed recall,orientation,abstraction and total score of MoCA in the observation group were significantly higher than those in the control group(the control group:4.48±0.37,5.23±0.29,2.43±0.27,3.37±0.31,5.01±0.33,5.27±0.26,25.79±1.17;the observation group:4.95±0.31,5.68±0.27,2.67±0.24,3.98±0.19,5.47±0.28,5.64±0.23,28.39±1.09)(t values were 4.17-10.51,all P<0.01).One month after discharge,the levels of FVC,FEV_(1) and FEV_(1)/FVC in the observation group were significantly higher than those in the control group,the control group:(2.59±0.18)L,(1.60±0.14)L,(61.78±4.01)%;the observation group:(2.89±0.19)L,(1.99±0.17)L,(68.86±3.99)%(t=7.21,11.14,7.87,all P<0.05).Conclusions TCM combined with resistance breathing training can effectively improve the hypoxic response of respiratory center in elderly obese patients with OSAHS.