专科护士主导的肺复张模式在急性呼吸窘迫综合征患者康复中应用的有效性与可行性分析

Effect of lung recruitment manoeuvre mode implemented by ICU specialist nurses on remission of patients with acute respiratory distress syndrome

目的探讨专科护士主导的肺复张(recruitment maneuver,RM)模式在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者中应用的有效性与可行性,以便为临床提供一种新的管理模式。方法采用随机对照试验,选取2018年1月至2021年8月本院重症医学科(intensive care unit,ICU)ICU收治的40例ARDS患者为研究对象,采用随机数字表法将患者分为对照组和试验组各20例。对照组采用常规医生主导的RM模式,试验组采用ICU专科护士主导的RM模式。比较干预后(第二次RM后)两组患者动脉血气分析指标、机械通气时间、ICU入住时间、RM次数、RM方案调动次数和并发症发生情况。结果两组患者第二次RM后1h和24h的动脉血氧分压(partial pressure of arterial oxygen,PaO_(2))、二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))、氧合指数(oxygenation index,OI)、机械通气时间、ICU入住时间和RM次数比较,差异无统计学意义(均P>0.05);试验组RM方案调动次数多于对照组,差异有统计学意义(P<0.05);两组均无并发症发生。结论ICU专科护士主导的RM模式在ARDS患者的应用可取得较好临床疗效,具有安全性和可行性。

Objective To analyse the effects of the lung recruitment manoeuvre(RM)mode implemented by ICU specialist nurses on remission of the patients with acute respiratory distress syndrome(ARDS),with the aim to explore the safety,feasibility and effectiveness of clinical implementation,and to further provide a new mode for patient management in nursing practice.Methods A total of 40 ARDS patients admitted into the ICU from January 2018 to August 2021 were randomly selected and divided into control group and trial group in equal number with a random number table.Patients in the control group was treated with a conventional RM mode implemented by doctors,and the RM mode implemented by the ICU specialist nurses was applied to the patients in trial group.The indexes of arterial blood gas analysis,mechanical ventilation time,length of ICU stay,number of RM,number of adjustments to a RM plan,and complication rate were compared between the two groups after the second RM implementation.Results There was no statistically significant difference in arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide and oxygenation index between the groups at 1h and 24h after the second RM implementation(P>0.05).There was no statistically significant difference in the number of RM,mechanical ventilation and length of ICU stay between the groups(P>0.05).The number of modifications of the RM plan in the trial group was significantly more than that in the control group(P<0.05).There was no complication of RM in both groups.Conclusions The RM mode implemented by ICU specialist nurses could achieve good clinical effects in the treatment of patients with ARDS.The approach is safe and practicable.