中医适宜技术联合集束化护理对脑卒中患者呼吸机相关性肺炎的防治作用

Effect of appropriate health technology of traditional Chinese medicine combined with bundle of care in treating stoke and preventing ventilator-associated pneumonia

目的探讨中医适宜技术联合集束化护理对脑卒中患者呼吸机相关性肺炎(VAP)的作用。方法选取2015年1~12月广州中医药大学第二附属医院重症医学科和神经内科收治的60例急性缺血性脑卒中患者,通过随机数字生成程序分为对照组和观察组,每组30例。两组患者按照ICU卒中临床路径给予常规治疗及呼吸机辅助通气。对照组患者采取ICU常规护理,观察组采取中医适宜技术联合集束化护理。采用卒中量表评分(NIHSS)评价两组患者神经功能缺损的改善情况,观察VAP发生率和呼吸机辅助通气脱机率。结果观察组患者的治疗总有效率为86.67%(26/30),明显高于对照组的63.33%(19/30),差异有统计学意义(P<0.05);治疗后观察组患者的NIHSS评分为(10.67±3.58)分,明显少于对照组的(15.22±2.77)分,观察组患者神经功能缺损改善情况优于对照组,差异有统计学意义(P<0.05)。再者,观察组VAP发生率为20.00%(6/30),明显少于对照组的46.67%(14/30),差异有统计学意义(P<0.05)。此外,观察组呼吸机辅助通气脱机率为40.00%(12/30),明显高于对照组的16.67%(5/30),差异有统计学意义(P<0.05)。结论中医适宜技术集束化综合护理能够减少脑卒中患者呼吸机相关性肺炎的发生,提高镇静唤醒作用,有利于患者早日脱离呼吸机,从而提高缺血性脑卒中患者生存质量。

Objective To investigate the effect of appropriate health technology of traditional Chinese medicine(TCM) combined with bundle of care in treating stoke and preventing ventilator-associated pneumonia(VAP).Methods Sixty patients with acute ischemic stroke were collected from ICU and Neurology Department of the Second Affiliated Hospital of Guangzhou University of TCM.They were divided into observation group and control group by random number generator,with 30 patients in each group.All patients were treated with conventional therapies of clinical pathway of stroke as well as the mechanical ventilation.Patients in control group were nursed with ICU care,while those in observation group were treated with appropriate health technology of TCM and bundle of care.The National Institutes of Health Stroke Scale(NIHSS) was used to evaluate the improvement of neurological function.And the incidences of VAP and ventilator weaning were observed.Results The total effective rate of observation group was86.67%(26/30),which was significantly better than that of the control group of 63.33%(19/30),with statistically significant difference(P<0.05).NIHSS after treatment in observation group was significantly lower than that in the control group [(10.67±3.58) vs(15.22±2.77),P<0.05].The improvement in neurologic impairment was significantly better in the observation group than the control group(P<0.05).Moreover,the incidence of VAP in the observation group was20.00%(6/30),which was significantly lower than that in the control group of 46.67%(14/30)(P<0.05).The incidence of ventilator weaning was 16.67%(5/30) in the control group and 40.00%(12/30) in the observation group,showing statistically significant difference(P<0.05).Conclusion Appropriate health technology of TCM and bundle of care could reduce the incidence of VAP.Meanwhile,it could improve waking up from the medical calming,which was beneficial to wean and enhance the live quality of patients with ischemic stroke.