目的:探讨医务人员对肺康复在重症脑卒中相关性肺炎中的应用体验,为提供高质量肺康复护理提供依据。方法:采用目的抽样法,于2024年1月~3月选取贵州省3家三级甲等医院神经科、呼吸与重症医学科和康复科的18名医务人员进行半结构化访谈。...目的:探讨医务人员对肺康复在重症脑卒中相关性肺炎中的应用体验,为提供高质量肺康复护理提供依据。方法:采用目的抽样法,于2024年1月~3月选取贵州省3家三级甲等医院神经科、呼吸与重症医学科和康复科的18名医务人员进行半结构化访谈。通过Colaizzi 7步分析法对访谈资料进行整理和分析。结果:总结出重症脑卒中SAP患者肺康复护理现状和障碍因素两个类别,共7个亚主题。肺康复护理现状亚主题为:SAP发生率高,肺康复护理意义重大;缺乏专业知识与技能;护理内容不统一且缺乏特异性。障碍因素归纳为:患者健康状况与认知不足;医护人员缺乏专业培训;人力资源不足;缺乏规范管理和效果评价标准。结论:重症脑卒中SAP患者的肺康复护理面临多重障碍,应加强患者及家属的健康教育;强化医护人员的培训,优化护理管理;合理配置人力资源;制定规范的肺康复干预流程,使重症脑卒中SAP患者真正获益于肺康复护理。Objective: To explore the healthcare providers’ experience of pulmonary rehabilitation in severe stroke-associated pneumonia and provide a basis for providing high-quality pulmonary rehabilitation care. Methods: Using purposive sampling, 18 healthcare providers from the departments of neurology, respiratory and critical care medicine, and rehabilitation in three tertiary-level A hospitals in Guizhou Province were selected from January to March 2024 for semi-structured interviews. The interview data were compiled and analyzed by Colaizzi 7-step analysis. Results: Two categories of current status of pulmonary rehabilitation care and barrier factors with seven sub-themes were summarized for SAP patients with severe stroke. The sub-themes of the current status of pulmonary rehabilitation care were: high incidence of SAP and significance of pulmonary rehabilitation care;lack of professional knowledge and skills;and inconsistency and lack of specificity of care. Barrier factors were summarized as: insufficient patient health status and awareness;lack of professional training for healthcare professionals;insufficient human resources;and lack of standardised management and outcome evaluation criteria. Conclusion: Pulmonary rehabilitation care for SAP patients with severe stroke faces multiple barriers. Health education for patients and their families should be strengthened;training for healthcare personnel should be enhanced and care management should be optimized;human resources should be reasonably allocated;and standardized pulmonary rehabilitation intervention processes should be developed, so that SAP patients with severe stroke can truly benefit from pulmonary rehabilitation care.展开更多
目的探讨中老年脑卒中相关性肺炎的流行病学特征、危险因素及病原菌分布情况。方法回顾性选取2020年1月至2023年9月于丽水市第二人民医院治疗的822例中老年脑卒中患者,根据是否发生脑卒中相关性肺炎将其分为发生组(n=217)和未发生组(n=6...目的探讨中老年脑卒中相关性肺炎的流行病学特征、危险因素及病原菌分布情况。方法回顾性选取2020年1月至2023年9月于丽水市第二人民医院治疗的822例中老年脑卒中患者,根据是否发生脑卒中相关性肺炎将其分为发生组(n=217)和未发生组(n=605)。收集两组患者的临床资料、病原菌培养及药敏试验结果。结果两组患者的年龄、住院时间、吸烟史、糖尿病、高血压、意识障碍、吞咽障碍、入院时美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分、低蛋白血症、是否留置胃管比较差异均有统计学意义(P<0.05)。Logistic回归分析显示,年龄>65岁、住院时间≥15d、吸烟史、糖尿病、意识障碍、吞咽障碍、入院时NIHSS评分≥13分、留置胃管均是脑卒中相关性肺炎的危险因素(P<0.05)。217例脑卒中相关性肺炎患者的痰液中共培养出251株致病菌,包括革兰阴性菌168株,革兰阳性菌72株,真菌11株。主要病原菌为肺炎克雷伯菌68株(27.1%)、铜绿假单胞菌50株(19.9%)、金黄色葡萄球菌41株(16.3%)、鲍曼不动杆菌25株(10.0%)。肺炎克雷伯菌对氨苄西林、庆大霉素的耐药率较高,铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌对氨苄西林、阿莫西林的耐药率均较高。结论中老年脑卒中相关性肺炎的发生和年龄、合并基础疾病、意识障碍、吞咽障碍、留置胃管等有关,且感染病原菌种类较多,临床上应加强识别高危因素,并根据药敏试验选择适当的抗菌药物治疗。展开更多
文摘目的:探讨医务人员对肺康复在重症脑卒中相关性肺炎中的应用体验,为提供高质量肺康复护理提供依据。方法:采用目的抽样法,于2024年1月~3月选取贵州省3家三级甲等医院神经科、呼吸与重症医学科和康复科的18名医务人员进行半结构化访谈。通过Colaizzi 7步分析法对访谈资料进行整理和分析。结果:总结出重症脑卒中SAP患者肺康复护理现状和障碍因素两个类别,共7个亚主题。肺康复护理现状亚主题为:SAP发生率高,肺康复护理意义重大;缺乏专业知识与技能;护理内容不统一且缺乏特异性。障碍因素归纳为:患者健康状况与认知不足;医护人员缺乏专业培训;人力资源不足;缺乏规范管理和效果评价标准。结论:重症脑卒中SAP患者的肺康复护理面临多重障碍,应加强患者及家属的健康教育;强化医护人员的培训,优化护理管理;合理配置人力资源;制定规范的肺康复干预流程,使重症脑卒中SAP患者真正获益于肺康复护理。Objective: To explore the healthcare providers’ experience of pulmonary rehabilitation in severe stroke-associated pneumonia and provide a basis for providing high-quality pulmonary rehabilitation care. Methods: Using purposive sampling, 18 healthcare providers from the departments of neurology, respiratory and critical care medicine, and rehabilitation in three tertiary-level A hospitals in Guizhou Province were selected from January to March 2024 for semi-structured interviews. The interview data were compiled and analyzed by Colaizzi 7-step analysis. Results: Two categories of current status of pulmonary rehabilitation care and barrier factors with seven sub-themes were summarized for SAP patients with severe stroke. The sub-themes of the current status of pulmonary rehabilitation care were: high incidence of SAP and significance of pulmonary rehabilitation care;lack of professional knowledge and skills;and inconsistency and lack of specificity of care. Barrier factors were summarized as: insufficient patient health status and awareness;lack of professional training for healthcare professionals;insufficient human resources;and lack of standardised management and outcome evaluation criteria. Conclusion: Pulmonary rehabilitation care for SAP patients with severe stroke faces multiple barriers. Health education for patients and their families should be strengthened;training for healthcare personnel should be enhanced and care management should be optimized;human resources should be reasonably allocated;and standardized pulmonary rehabilitation intervention processes should be developed, so that SAP patients with severe stroke can truly benefit from pulmonary rehabilitation care.
文摘目的探讨中老年脑卒中相关性肺炎的流行病学特征、危险因素及病原菌分布情况。方法回顾性选取2020年1月至2023年9月于丽水市第二人民医院治疗的822例中老年脑卒中患者,根据是否发生脑卒中相关性肺炎将其分为发生组(n=217)和未发生组(n=605)。收集两组患者的临床资料、病原菌培养及药敏试验结果。结果两组患者的年龄、住院时间、吸烟史、糖尿病、高血压、意识障碍、吞咽障碍、入院时美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分、低蛋白血症、是否留置胃管比较差异均有统计学意义(P<0.05)。Logistic回归分析显示,年龄>65岁、住院时间≥15d、吸烟史、糖尿病、意识障碍、吞咽障碍、入院时NIHSS评分≥13分、留置胃管均是脑卒中相关性肺炎的危险因素(P<0.05)。217例脑卒中相关性肺炎患者的痰液中共培养出251株致病菌,包括革兰阴性菌168株,革兰阳性菌72株,真菌11株。主要病原菌为肺炎克雷伯菌68株(27.1%)、铜绿假单胞菌50株(19.9%)、金黄色葡萄球菌41株(16.3%)、鲍曼不动杆菌25株(10.0%)。肺炎克雷伯菌对氨苄西林、庆大霉素的耐药率较高,铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌对氨苄西林、阿莫西林的耐药率均较高。结论中老年脑卒中相关性肺炎的发生和年龄、合并基础疾病、意识障碍、吞咽障碍、留置胃管等有关,且感染病原菌种类较多,临床上应加强识别高危因素,并根据药敏试验选择适当的抗菌药物治疗。
