危重症专职护理联合改良式体位管理在慢性阻塞性肺疾病呼吸衰竭机械通气患者中的应用

Application of critical full-time nursing combined with improved posture management in patients with chronic obstructive pulmonary disease and respiratory failure undergoing mechanical ventilation

目的探讨危重症专职护理联合改良式体位管理在慢性阻塞性肺疾病呼吸衰竭(RF)机械通气(MV)患者中的应用效果。方法选取2021年1月至2023年1月九江市第一人民医院收治的61例慢性阻塞性肺疾病RF患者作为研究对象,按照随机数字表法分为对照组(30例)和观察组(31例)。对照组患者采用危重症专职护理,观察组患者采用危重症专职护理联合改良式体位管理。比较两组患者的心功能、血气指标、临床指标、并发症发生率和呼吸机相关性肺炎(VAP)发生率。结果两组患者护理前的左室射血分数(LVEF)、第1秒用力呼气容积(FEV1)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))比较,差异无统计学意义(P>0.05)。两组护理后的LVEF、FEV1、PaO_(2)均高于本组护理前,PaCO_(2)均低于本组护理前,差异有统计学意义(P<0.05);观察组护理后的LVEF、FEV1、PaO_(2)均高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。观察组的机械通气时间、ICU入住时间和住院时间均短于对照组,VAP发生率和并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论在行MV治疗的慢性阻塞性肺疾病RF患者中应用危重症专职护理联合改良式体位管理可改善心功能及血气指标,缩短机械通气、ICU入住及住院时间,降低并发症及VAP发生率,值得推广。

Objective To explore the application effect of critical full-time nursing combined with improved posture management in patients with chronic obstructive pulmonary disease and respiratory failure(RF)undergoing mechanical ventilation(MV).Methods A total of 61 RF patients with chronic obstructive pulmonary disease admitted to Jiujiang NO.1 People's Hospital from January 2021 to January 2023 were selected as the research objects.According to random number table method,they were divided into control group(30 cases)and observation group(31 cases).Patients in the control group were received critical full-time nursing,while patients in the observation group were received critical full-time nursing combined with improved posture management.The cardiac function,blood gas indexes,clinical indexes,incidence of complications and incidence of ventilator-associated pneumonia(VAP)were compared between the two groups.Results There were no statistically significant differences in left ventricular ejection fraction(LVEF),forced expiratory volume in one second(FEV1),partial pressure of oxygen in arterial blood(PaO_(2))and partial pressure of carbon dioxide in arterial blood(PaCO_(2))between the two groups before nursing(P>0.05).The LVEF,FEV1 and PaO_(2) of the two groups after nursing were higher than those before nursing,and PaCO_(2) of the two groups after nursing were lower than those before nursing,and the differences were statistically significant(P<0.05).The LVEF,FEV1 and PaO_(2) of the observation group after nursing were higher than those of the control group,and PaCO_(2) was lower than that of the control group,and the differences were statistically significant(P<0.05).The mechanical ventilation time,ICU stay time and hospitalization time of the observation group were shorter than those of the control group,and the incidence of VAP and complications were lower than those of the control group,and the differences were statistically significant(P<0.05).Conclusion The application of critical full-time nursing combined with improved posture management in chronic obstructive pulmonary disease and RF patients treated with MV can improve cardiac function and blood gas indexes,shorten the time of mechanical ventilation,ICU admission and hospitalization,and reduce the incidence of complications and VAP,which is worthy of promotion.