阶梯式早期活动方案在肿瘤患者肺栓塞中的应用

Application of stepwise early activity program in patients with pulmonary embolism

目的:制订肿瘤患者肺栓塞阶梯式早期活动方案,为改善肺栓塞患者目前活动现状提供理论和实践依据。方法:本研究为实验性研究,将四川省肿瘤医院2021年1月1日至2022年3月31日确诊为肺栓塞的92例肿瘤患者采用随机数字表法分为对照组与试验组各46例。对照组实施常规活动方案,卧床7 d,患者自行在床上活动;试验组通过循证护理获得肺栓塞早期活动方案的最佳证据,组建以护士为主导的肺栓塞阶梯式早期活动团队,最终构建阶梯式早期活动方案并实施。比较2组患者病死率、入住ICU后3、7 d新发静脉血栓栓塞症(VTE)情况、ICU住院天数以及患者舒适度。结果:对照组与试验组肿瘤患者确诊肺栓塞后30 d内病死率分别为4.35%(2/46)和2.17%(1/46),2组比较差异无统计学意义(χ^(2)=0.35,P>0.05);对照组患者入住ICU后3、7 d新发VTE发生率分别为15.22%(7/46)和26.09%(12/46),试验组分别为4.35%(2/46)和4.35%(2/46),其中入住ICU后7 d 2组新发VTE发生率比较差异有统计学意义(χ^(2)=8.43,P<0.05);对照组的ICU住院天数、舒适状况量表(GCQ)得分分别为(15.74±11.11)d、(64.30±15.54)分,试验组分别为(11.07±5.63)d、(73.84±11.73)分,2组比较差异均有统计学意义(t=-2.55、-3.32,均P<0.05)。结论:基于循证构建肺栓塞肿瘤患者阶梯式早期活动方案,不会造成患者的病死率的增加,确保了患者的安全性,降低了新发血栓发生率以及ICU住院天数,提高了患者在治疗肺栓塞期间的舒适性,值得临床推广应用。

Objective To formulate a ladder type early activity program in order to provide a theoretical and practical basis for improving the current activity status of tumor patients with pulmonary embolism.MethodsThis research was conducted experimentally.A total of 92 tumor patients diagnosed as pulmonary embolism from January 1,2021 to March 31,2022 in Sichuan Cancer Hospital were divided into control group and experimental group with 46 cases each by random number table method.In the control group,a routine activity program was carried out,and the patients were confined to bed for 7 days.The experimental group obtained the best evidence of early pulmonary embolism activity plan through evidence-based nursing,formed a nurse-led ladder type early pulmonary embolism activity team,and finally constructed and implemented the ladder type early activity plan.The mortality rate,new thrombosis in ICU for 3 days and 7 days,length of stay in ICU and patients′comfort were compared between the two groups.ResultsThe mortality rates within 30 days after the diagnosis of pulmonary embolism were 4.35%(2/46)and 2.17%(1/46)respectively in the control group and the experimental group,with no significant difference between the two groups(χ^(2)=0.35,P>0.05).The rates of new thrombosis were 15.22%(7/46)and 26.09%(12/46)in the control group,and 4.35%(2/46)and 4.35%(2/46)in the experimental group,respectively at 3 and 7 days after ICU admission,with a significant difference between the two groups at 7 days after ICU admission(χ^(2)=8.43,P<0.05).The length of stay in ICU and the score of General Comfort Questionnaire(GCQ)were(15.74±11.11)days and(64.30±15.54)points in the experimental group,respectively,while those in the control group were(11.07±5.63)days and(73.84±11.73)points,respectively.The difference between the two groups was statistically significant(t=-2.55,-3.32,both P<0.05).ConclusionsThe evidence-based ladder type early activity program for patients with pulmonary embolism caused by tumor will not increase the mortality of patients,but can ensure the safety of patients,reduce the incidence of new thrombosis and the length of ICU stay,improve the comfort of patients during the treatment of pulmonary embolism.It is worthy of clinical application.