基于患者健康参与模型的护理方案在无创正压通气患者中的应用效果研究

Application effect of care program based on the patient health participation model in patients with non-invasive positive pressure ventilation

目的 探讨基于患者健康参与模型(PHE模型)的护理方案在接受无创正压通气(NPPV)治疗的呼吸衰竭患者中的应用效果。方法 采用便利抽样法选取2021年11月-2022年11月在复旦大学附属中山医院内科重症监护室接受NPPV治疗达48 h以上的呼吸衰竭患者104例,采用随机数字表法分为观察组与对照组,各52例。对照组接受常规的NPPV护理方法,观察组在对照组基础上实施基于PHE模型的护理方案。比较2组患者在NPPV 4 h、24 h和48 h时的人机不同步指数、无创通气依从性、呼吸困难评分和血气分析指标的差异,以及患者NPPV期间的舒适度和短期预后情况。结果 在NPPV 48 h内,观察组的人机不同步指数、无创通气依从性整体优于对照组(P<0.05),且观察组呼吸困难评分在NPPV 4 h已明显低于对照组(P<0.05)。同时,观察组的P(CO_(2))在NPPV 48 h内整体处于正常范围,而对照组则整体偏低,2组差异有统计学意义(P<0.05)。同时,观察组NPPV期间的舒适度评分高于对照组,ICU留置时间短于对照组,差异均有统计学意义(P<0.05)。结论 基于PHE模型的护理干预能有效改善呼吸衰竭患者在NPPV治疗期间的舒适度,提升其人机同步性和治疗依从性,从而在NPPV开始后更短的时间内改善患者的呼吸与氧合状况,最终缩短患者ICU留置时间,改善临床预后。

Objective To explore the application effect of a care plan based on the Patient Health Engagement(PHE)Model in patients with respiratory failure treated with non-invasive positive pressure ventilation(NPPV).Methods Patients with respiratory failure who received NPPV for 48 hours or more in the intensive care unit(ICU)of internal medicine of Zhongshan Hospital Affiliated to Fudan University from November 2021 to November 2022 were selected by a convenience sampling method,and were divided into the observation group and the control group using a random number table method(n=52 for each group).The control group received the conventional NPPV care,and the intervention group implemented the care program based on the PHE model.The differences in asynchrony index,non-invasive ventilation compliance,dyspnea score,and blood gas analysis indexes at 4 h,24 h,and 48 h of NPPV were compared between the two groups,as well as patients'comfort scores and short-term prognosis during NPPV.Results Within 48 h of NPPV,the asynchrony index and non-invasive ventilation compliance in the intervention group were overall better than those in the control group(P<0.05),and the dyspnea score in the intervention group was significantly lower than that in the control group at 4 h of NPPV(P<0.05).Meanwhile,P(CO2)in the intervention group was overall in the normal range during 48 h of NPPV,while that in the control group was overall low,and the difference between the two groups was statistically significant(P<0.05).Moreover,the comfort score during NPPV in the intervention group was higher than that in the control group,and the ICU stay time in the intervention group was less than that in the control group,and all the differences were statistically significant(P<0.05).Conclusion The care plan based on the PHE model can effectively improve the comfort level of patients with respiratory failure during NPPV,enhance their human-machine synchronization and treatment compliance,thus improving the respiratory and oxygenation status of patients within a shorter period of time after NPPV,and ultimately reducing the ICU stay of patients and improving clinical prognosis.