多频震荡排痰机在重症肺炎患者的护理研究

徐芳芳; 吴霞云; 王亚萍; 卢俊梅; 庞璐; 王丹琼

doi:10.16766/j.cnki.issn.1674-4152.001800

多频震荡排痰机在重症肺炎患者的护理研究

doi: 10.16766/j.cnki.issn.1674-4152.001800

衢州市人民医院重症医学科，浙江衢州 324000

基金项目:

浙江省基础公益计划项目 LGF19H150002

详细信息

通讯作者:
王丹琼，E-mail：wjmsd2016@163.com

中图分类号: R563.1 R473.56
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- 文章访问数: 279
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- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2020-03-04
- 网络出版日期: 2022-02-19

Study on Nursing Care of Patients with Severe Pneumonia with Multi-frequency Vibrating Sputum Extractor

Department of critical medicine, Quzhou people's Hospital, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的探讨多频震荡排痰机在ICU重症肺炎患者的护理效果，为其应用提供参考。方法按随机数字法将衢州市人民医院2018年1月—2019年12月收治的122例ICU重症肺炎患者分为2组，每组61例，2组患者均给予常规治疗，在此基础上对照组应用传统手工扣背排痰，观察组应用多频震荡排痰机排痰。治疗后，比较2组日均排痰量、体温(T)、降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、临床肺部感染评分(CPIS)、血管活性药物使用时间、机械通气时间、ICU住院时间、总住院时间、急性生理和慢性健康状况评分(APACHE Ⅱ)及28 d病死率。结果治疗后观察组总有效率(95.08%)显著高于对照组(77.05%，χ²=8.296，P=0.016)。治疗后，2组PCT、CRP、WBC、PaCO₂、T、CPIS水平均明显降低(均P < 0.05)，且观察组低于对照组(均P < 0.05)；2组PaO₂水平升高(均P < 0.05)，且观察组高于对照组(P < 0.05)；观察组日均排痰量明显高于对照组(P < 0.05)，观察组血管活性药物使用时间、机械通气时间、ICU住院时间、总住院时间明显短于对照组(均P < 0.05)；2组APACHE Ⅱ评分显著降低(均P < 0.05)，且观察组低于对照组(P < 0.05)。治疗后观察组28 d病死率(1.64%)低于对照组(8.20%)，但差异无统计学意义(χ²=1.578，P=0.209)。结论应用多频震荡排痰机治疗ICU重症肺炎，可明显缩短患者血管活性药物使用时间、机械通气时间、ICU住院时间，促进患者排痰，减轻患者炎症反应，改善患者血气水平，治疗效果较佳。
- ICU重症肺炎 /
- 多频震荡排痰机 /
- 呼吸道管理 /
- 治疗效果
Abstract: Objective To explore the nursing effect of multi-frequency concussion sputum extractor in ICU patients with severe pneumonia. Methods According to the random number method, 122 patients with severe pneumonia in ICU admitted by Quzhou City People's hospital, from January 2018 to December 2019, were divided into two groups, with 61 patients in each group. Both groups were given conventional treatment. On this basis, the control group was treated with traditional manual back button sputum drainage, and the observation group was treated with multi-frequency shock sputum drainage machine. After treatment, the average daily sputum volume, temperature (T), calcitonin (PCT) and c-reactive protein (CRP) and white blood cell count (WBC), arterial blood oxygen partial pressure, arterial blood (PaO₂), CO₂ partial pressure (PaCO₂) and clinical pulmonary infection score (CPIS), vascular active drug use time, mechanical ventilation, ICU length of hospital stay, the total length of hospital stay, acute physiology and chronic health evaluation (APACHE Ⅱ) and 28 d case fatality rate of change were compared between two groups. Results The total effective rate of the observation group (95.08%) was significantly higher than that of the control group (77.05%, χ²=8.296, P=0.016). After treatment, the levels of PCT, CRP, WBC, PaCO₂, T and CPIS in both groups were significantly reduced (all P < 0.05), and the observation group was lower than the control group (all P < 0.05). PaO₂ level increased in the two groups (all P < 0.05), and was higher in the observation group than in the control group (P < 0.05). The average daily sputum output of the observation group was significantly higher than that of the control group (P < 0.05). After treatment, the use time, mechanical ventilation time, length of stay in ICU and total length of stay in the observation group were significantly shorter than those in the control group (all P < 0.05). APACHE Ⅱ scores of the two groups were significantly reduced (all P < 0.05), and the observation group was lower than the control group (P < 0.05).The case fatality rate of the observation group on day 28 (1.64%) was lower than that of the control group (8.20%), but the difference was not statistically significant (χ²=1.578, P=0.209). Conclusion The application of multi-frequency oscillatory sputum ejector in the treatment of severe pneumonia in ICU can significantly shorten the use time of vasoactive drugs, mechanical ventilation time and ICU hospitalization time, promote the sputum ejector, reduce the inflammatory response of patients, improve the blood gas level of patients, and the treatment effect is better.
- Severe pneumonia in ICU /
- Multi-frequency vibrating sputum exhauster /
- Respiratory management /
- Treatment effect

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表 1 2组重症肺炎患者临床资料比较(x ±s)

组别	例数	性别(例)		年龄(岁)	病程(d)	APACHE Ⅱ评分(分)
组别	例数	男性	女性	年龄(岁)	病程(d)	APACHE Ⅱ评分(分)
观察组	61	35	26	53.16±10.34	4.02±1.05	21.73±4.12
对照组	61	33	28	53.72±10.28	3.91±1.12	21.65±4.06
统计量		0.133^a		-0.300^b	0.560^b	0.108^b
P值		0.715		0.765	0.577	0.914
注：^a为χ²值，^b为t值。

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表 2 2组重症肺炎患者相关指标比较(x ±s)

组别	例数	血管活性药物使用时间(d)	日均排痰量(mL)	机械通气时间(d)	ICU住院时间(d)	总住院时间(d)		PCT(ng/mL)
组别	例数	血管活性药物使用时间(d)	日均排痰量(mL)	机械通气时间(d)	ICU住院时间(d)	总住院时间(d)		治疗前	治疗后
观察组	61	4.53±0.86	33.27±6.28	5.29±1.13	7.56±1.40	17.27±3.09		25.60±4.92	1.28±0.27^a
对照组	61	7.62±1.39	26.81±5.06	10.07±1.92	11.38±2.64	25.16±5.87		25.37±4.89	3.12±0.59^a
t值		-14.765	6.256	-16.757	-9.984	-9.290		0.259	-22.148
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001		0.796	＜0.001

组别	例数	CRP(ng/L)		WBC(×10⁹)		PaO₂		PaCO₂
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	61	170.15±33.62	16.54±3.22^a	18.01±3.50	6.27±1.43^a	51.23±10.17	73.08±14.20^a	56.38±11.25	40.62±7.91^a
对照组	61	171.36±35.11	45.62±9.07^a	17.86±3.56	10.93±2.04^a	51.14±10.09	62.67±12.43^a	56.19±10.97	47.31±9.23^a
t值		-0.194	-23.598	0.235	-14.209	0.049	4.308	0.094	-4.298
P值		0.846	＜0.001	0.815	＜0.001	0.961	＜0.001	0.925	＜0.001

组别	例数	T(℃)		APACHE Ⅱ评分(分)		CPIS评分(分)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前		治疗后
观察组	61	39.43±0.19	36.91±0.13^a	21.73±4.12	13.57±2.40^a	8.35±1.71		4.39±0.98^a
对照组	61	39.38±0.16	37.82±1.15^a	21.65±4.06	16.92±3.05^a	8.32±1.69		6.07±1.15^a
t值		1.572	-35.806	1.108	-6.742	0.098		-8.684
P值		0.119	＜0.001	0.914	＜0.001	0.923		＜0.001
注：与治疗前比较，^aP < 0.05。

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