摘要
目的评价对重症监护病房(ICU)机械通气患者应用早期运动安全管理方案的有效性和安全性。方法采用历史对照的观察性研究方法,选择2019年4月至6月济宁医学院附属医院ICU收治的45例重症呼吸衰竭机械通气患者作为观察组,实施早期运动安全管理方案,包括:联合ICU医生、ICU护士、呼吸治疗师、康复师、营养师和心理咨询师组建多学科安全管理团队,共同制定患者早期运动计划;配置运动及安全防护设备;评估早期运动风险,制定早期运动处方;制定营养处方和心理处方;开展患者早期运动宣教并与患者及时交流;加强团队成员培训。从2019年1月至3月入院接受机械通气治疗的重症呼吸衰竭患者中,选择45例性别、年龄和人工气道方式与观察组相匹配的患者作为对照组,该组患者机械通气常规护理包括:病情监护、用药护理、环境管理和常规检查协助等。比较两组患者护理干预后抑郁焦虑情绪、舒适度、肺功能和生活质量的改善情况,以及并发症发生情况。结果两组患者性别、年龄和人工气道方式比较差异均无统计学意义。实施护理干预前,两组患者抑郁焦虑情绪、舒适度、肺功能和生活质量比较无明显差异。给予不同护理方案干预后,两组患者上述情况均明显改善,且以观察组改善更为显著,表现为:观察组干预后患者医院焦虑抑郁量表(HAD)评分和用力肺活量(FVC)明显低于对照组〔HAD评分(分):10.80±2.54比17.51±3.66,FVC(L):1.81±0.42比2.23±0.39,均P<0.01〕,舒适状况量表(GCQ)评分、1秒用力呼气容积(FEV1)、FEV1/FVC比值、FEV1占预计值百分比(FEV1%)和简明健康调查量表(SF-36)各个维度评分均明显高于对照组〔GCQ评分(分):110.87±5.33比96.93±3.02,FEV1(L):1.99±0.37比1.71±0.15,FEV1/FVC比值:0.88±0.04比0.84±0.03,FEV1%:(88.98±8.57)%比(80.41±4.45)%,心理功能评分(分):49.74±9.88比40.17±8.95,躯体功能评分(分):27.65±9.46比20.32±9.53,社会关系评分(分):62.14±6.33比50.28±8.76,一般健康评分(分):38.61±8.48比30.63±8.93,均P<0.01〕。观察组患者并发症总体发生率明显低于对照组(24.44%比57.78%,P<0.01)。结论对ICU机械通气患者应用早期运动安全管理方案,可以提高临床疗效,减少并发症的发生;同时可以进一步规范医护人员的行为,保证早期运动顺利开展。
Objective To evaluate the effectiveness and safety of early exercise safety management in patients undergoing mechanical ventilation in intensive care unit (ICU).Methods A prospective historical control observation was conducted. Forty-five patients with severe respiratory failure undergoing mechanical ventilation admitted to the ICU of Affiliated Hospital of Jining Medical University from April to June in 2019 were enrolled in the observation group and implemented early exercise safety management, including establishing multidisciplinary safety management team with ICU doctors, ICU nurses, respiratory therapists, rehabilitation therapists, dietitians and psychological consultants to jointly develop early exercise plan;equipping with sports and safety protection equipment;assessing the early exercise risks, formulating early exercise prescriptions;formulating the nutritional and psychological prescriptions;carrying out the propaganda and education in the early exercise process of patients and communicating with patients timely;strengthening team training. Other 45 patients with severe respiratory failure admitted for mechanical ventilation from January to March in 2019 were enrolled in the control group, whose gender, age and artificial airway conditions were matched with those in the observation group. Routine mechanical ventilation nursing was performed, including condition monitoring, medication nursing, environmental management and routine examination assistance. The improvement of depression, anxiety, comfort, lung function, and quality of life before and after nursing intervention were observed, and the occurrence of complications was recorded.Results There was no significant difference in gender, age or artificial airway conditions between the two groups. Before nursing intervention, there was no significant difference in depression, anxiety, comfort, lung function and quality of life between the two groups. After the intervention of different nursing programs, the above conditions of the two groups were significantly improved, and the improvement was more significant in the observation group, which showed that the hospital anxiety and depression scale (HAD) score and forced vital capacity (FVC) of the observation group were significantly lower than those of the control group [HAD score: 10.80±2.54 vs. 17.51±3.66, FVC (L): 1.81±0.42 vs. 2.23±0.39, both P < 0.01], while the general comfort questionnaire (GCQ) score, forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, FEV1 percentage of predicted (FEV1%) and each dimension score of 36-item short form health survey (SF-36) scale were significantly higher than those of the control group [GCQ score: 110.87±5.33 vs. 96.93±3.02, FEV1 (L): 1.99±0.37 vs. 1.71±0.15, FEV1/FVC ratio: 0.88±0.04 vs. 0.84±0.03, FEV1%: (88.98±8.57)% vs. (80.41±4.45)%, mental function score: 49.74±9.88 vs. 40.17±8.95, physical function score: 27.65±9.46 vs. 20.32±9.53, social relationship score: 62.14±6.33 vs. 50.28±8.76, general health score: 38.61±8.48 vs. 30.63±8.93, all P < 0.01]. The overall incidence of complications in the observation group was significantly lower than that in the control group (24.44% vs. 57.78%, P < 0.01).Conclusions Early exercise safety management scheme for patients undergoing mechanical ventilation in ICU can improve clinical efficacy and reduce complications. At the same time, it can further standardize the behaviors of medical staff and ensure the early exercise.
作者
张立文
颜冉冉
周媛媛
杨莹
王慧慧
蒋娜
张永浩
Zhang Liwen;Yan Ranran;Zhou Yuanyuan;Yang Ying;Wang Huihui;Jiang Na;Zhang Yonghao(Department of Intensive Care Unit,Affiliated Hospital of Jining Medical University,Jining 272000,Shandong,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第7期840-845,共6页
Chinese Critical Care Medicine
基金
山东省医药卫生科技发展计划项目(2016WS0177)。
关键词
早期运动
安全管理
重症监护病房
机械通气
Early Exercise
Safe management
Intensive care unit
Mechanical ventilation
