Application effect of individualised nursing combined with cluster nursing in edaravone treatment of acute paraquat poisoning
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摘要:
目的 探讨在依达拉奉治疗急性百草枯中毒中应用个性化护理联合集束化护理的价值及对血清炎性因子的影响。 方法 选取新乡医学院第三附属医院2015年1月—2020年1月收治的急性百草枯中毒患者54例，均采用依达拉奉治疗，按照随机数字法分为对照组(27例，采用个性化护理)与观察组(27例，采用个性化护理联合集束化护理)。对比2组护理前后的TNF-α、ALT、Cr、血清白介素-18水平，观察并记录2组28 d存活率与死亡率。 结果 相较于对照组，观察组患者护理后的TNF-α、血清白介素-18水平更低[(74.75±8.58)ng/L vs. (112.42±12.39)ng/L, (145.42±13.85)ng/L vs. (164.57±15.34)ng/L, t=12.988、4.815，均P < 0.05]。2组急性百草枯中毒患者护理前ALT、Cr水平差异无统计学意义(均P>0.05)]；相较于对照组，观察组患者护理后的ALT、Cr水平更低[(122.82±15.65)U/mL vs. (236.15±28.58)U/mL, (138.56±15.77)μmol/L vs. (181.36±19.34)μmol/L, t=18.073、8.912，均P < 0.05]。观察组急性百草枯中毒患者的28 d存活率为48.15%，对照组为22.22%，差异有统计学意义(χ2=3.979，P=0.046)。 结论 急性百草枯中毒患者给予依达拉奉治疗与联合护理(个性化护理+集束化护理)，可有效改善TNF-α、血清白介素-18、ALT、Cr等相关生化指标，提高患者存活率及预后质量。 Abstract:Objective To explore the application effect of individualised nursing combined with cluster nursing in the treatment of acute paraquat poisoning with edaravone. Methods Fifty-four patients with acute paraquat poisoning admitted at the Third Affiliated Hospital of Xinxiang Medical College from January 2015 to January 2020 were selected and treated with edaravone. They were randomly divided into the control group (27 cases, using personalised nursing) and observation group (27 cases, using personalised nursing combined with cluster nursing). The levels of tumour necrosis factor (TNF)-α, ALT, Cr and serum interleukin (IL)-18 were compared between the two groups before and after nursing. The 28-day survival rate and mortality of the two groups were observed and recorded. Results Compared with the control group, the levels of TNF-α and IL-18 in the observation group were lower after nursing, and the difference was statistically significant [(74.75±8.58) ng/L vs. (112.42±12.39) ng/L, (145.42±13.85) ng/L vs. (164.57±15.34) ng/L, t=12.988, 4.815, all P < 0.05]. No significant difference was observed in ALT and Cr levels between the two groups before nursing (all P>0.05); compared with the control group, the levels of ALT and Cr in the observation group were lower after nursing, and the difference was statistically significant [(122.82±15.65) U/mL vs. (236.15±28.58) U/mL, (138.56±15.77) μmol/L vs. (181.36±19.34) μmol/L, t=18.073, 8.912, all P < 0.05]. The 28-day survival rate of patients in the observation group was 48.15%, and that of patients in the control group was 22.22%. Compared with the control group, the 28-day survival rate of patients in the observation group was higher, and the difference was statistically significant (χ2=3.979, P=0.046). Conclusion Edaravone treatment and combined nursing (individualised nursing+cluster nursing) can effectively improve the related biochemical indexes such as TNF-α, serum IL-18, ALT and Cr and increase the survival rate and prognosis of patients with acute paraquat poisoning. -
表 1 2组急性百草枯中毒患者一般资料比较
组别 例数 性别(男/女, 例) 年龄(x±s, 岁) 百草枯口服量(x±s, mL) 体重(x±s, kg) 观察组 27 14/13 38.65±3.39 106.42±9.47 61.57±6.74 对照组 27 15/12 38.53±3.35 106.39±9.45 61.52±6.71 统计量 0.075a 0.131b 0.012b 0.027b P值 0.785 0.896 0.991 0.978 注：a为χ2值，b为t值。 
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表 2 2组急性百草枯中毒患者护理前后炎症因子水平比较(x±s，ng/L)
组别 例数 TNF-α 血清白介素-18 护理前 护理后 护理前 护理后 观察组 27 179.39±16.72 74.75±8.58a 133.27±12.56 145.42±13.85a 对照组 27 179.41±16.75 112.42±12.39a 133.25±12.52 164.57±15.34a t值 0.004 12.988 0.007 4.815 P值 0.997 < 0.001 0.995 < 0.001 注：与护理前比较，aP < 0.05。
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表 3 2组急性百草枯中毒患者护理前后ALT、Cr水平比较(x±s)
组别 例数 ALT(U/mL) Cr(μmol/L) 护理前 护理后 护理前 护理后 观察组 27 28.56±2.72 122.82±15.65a 87.46±8.42 138.56±15.77a 对照组 27 28.58±2.75 236.15±28.58a 87.32±8.45 181.36±19.34a t值 0.027 18.073 0.061 8.912 P值 0.979 0.010 0.952 < 0.001 注：与护理前比较，aP < 0.05。
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