«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2024年06期

页码:

948-952

栏目:

论著

出版日期:

2024-12-25

文章信息/Info

Title:

Application of early warning mechanism in omnidirectional non-blind spot management of AECOPD with respiratory failure

作者:

李 姣¹; 张 莉¹; 侯云秋¹; 孙 腾¹; 梁 艳¹; 霍 博²

710032西安,空军军医大学第一附属医院急诊科¹
710032 西安,空军军医大学第一附属医院呼吸与危重医学科²

Author(s):

Li Jiao¹;  Zhang Li¹;  Hou Yunqiu¹;  Sun Teng¹;  Liang Yan¹;  Huo Bo².

¹Emergency Department, The First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China; ²Respiratory and Critical Care Medicine Department, The First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

关键词:

急性加重期; 肺疾病; 慢性阻塞性;  预警机制;  全方位无盲点管理;  不良事件

Keywords:

Acute exacerbation of chronic obstructive pulmonary disease;  Early warning mechanism;  Omnidirectional non-blind spot management;  Adverse events

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2024.06.017

摘要:

目的 分析预警机制全方位无盲点管理模式对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)并发呼吸衰竭(respiratory failure, RF)住院时间和不良事件的影响。方法 选取我院2022年1月至2024年1月我院收治的AECOPD并RF患者129例,随机分为观察组65例和对照组64例,对照组予以常规管理,观察组采用预警机制下全方位无盲点管理。对比两组ICU治疗时间、机械通气时间、住院时间差异,分析救治前后Kolcaba舒适状况量表(general comfort questionnaire, GCQ)、生活质量St George's呼吸问卷(St George's respiratory questionnaire, SGRQ)及住院期间不良事件呼吸机相关性肺炎风险(ventilator-associated pneumonia, VAP)、呼吸机依赖(ventilator dependence, VD)、管道堵塞、面罩漏气、窒息差异。结果 观察组ICU治疗时间、机械通气时间及住院时间分别为(16.68±2.01)d、(8.28±1.36)d、(29.44±3.95)d低于对照组(18.07±1.87)d、(9.01±1.88)d、(31.38±3.67)d(P<0.01); 两组治疗后生理、心理、社会和环境舒适度评分较治疗前升高(P<0.05),观察组治疗后生理评分(18.74±3.04)分、心理评分(31.88±3.54)分、社会评分(27.74±3.68)分和环境舒适度评分(18.26±2.74)分高于对照组(14.28±2.57)分、(23.69±3.28)分、(22.38±3.19)分、(15.64±2.47)分(P<0.05); 两组治疗后呼吸症状、活动受限和疾病影响评分较治疗前降低(P<0.05),观察组治疗后呼吸症状评分(37.64±4.21)分、活动受限评分(36.37±4.64)分、疾病影响评分(38.28±4.97)分低于对照组(40.25±4.85)分、(36.37±4.64)分、(44.37±4.58)分(P<0.05); 观察组住院期间不良事件发生率6.15%低于对照组20.31%(P<0.05)。结论 预警机制下全方位无盲点管理模式应用于AECOPD并RF,缩短住院治疗时间,控制不良事件,提高舒适度、生活质量,具有临床意义。

Abstract:

Objective To explore the effects of omnidirectional non-blind spot management model under early warning mechanism on hospital stay and occurrence of adverse events in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure(RF). Methods All of 129 patients with AECOPD and RF admitted to department of the hospital from January 2022 to January 2024 were selected and randomly divided into observation group(n=65)and control group(n=64)by the single-double number method. The control group was given routine management model while the observation group was given omnidirectional non-blind spot management model under early warning mechanism. The differences in treatment time and hospital stay(ICU treatment time, mechanical ventilation time, hospital stay)were compared between the two groups of patients, and the differences in comfort [Kolcaba General Comfort Questionnaire(GCQ)] and quality of life [St George's Respiratory Questionnaire(SGRQ)] before and after intervention and occurrence of adverse events [ventilator-associated pneumonia(VAP), ventilator dependence(VD), pipeline blockage, mask leakage, asphyxia] during hospitalization were analyzed. Results The ICU treatment time, mechanical ventilation time and hospital stay with(16.68±2.01)d,(8.28±1.36)d and(29.44±3.95)d in observation group were shorter than(16.68±2.01)d,(8.28±1.36)d and(29.44±3.95)d in control group(P<0.01). After intervention, the comfort scores of physiology, psychology, society and environment in the two groups were increased compared with those before intervention(P<0.05), and after intervention, the physiological score(18.74±3.04), psychological score(31.88±3.54), social score(27.74±3.68)and environmental comfort score(18.26±2.74)in the observation group were higher than those in the control group(14.28±2.57),(23.69±3.28)and(22.38±3.19),(15.64±2.47)(P<0.05). The scores of respiratory symptoms, activity limitation and disease impact in the two groups were decreased after intervention compared to before treatment(P<0.05), and the respiratory symptom score(37.64±4.21), activity limitation score(36.37±4.64)and disease impact score(38.28±4.97)of the observation group after intervention were lower than those of the control group(40.25±4.85),(36.37±4.64)and(44.37±4.58)(P<0.05). During hospitalization, the incidence rate of total adverse events in observation group with 6.15% was lower compared with 20.31% in control group(P<0.05). Conclusion The application of omnidirectional non-blind spot management model under early warning mechanism in AECOPD with RF is helpful for the treatment progress of patients, and can shorten the hospitalization treatment time, control the occurrence of adverse events, and improve the comfort and quality of life.

参考文献/References:

1 李 林, 刘 璐, 何 芳. 经鼻高流量湿化氧疗治疗AECOPD合并Ⅱ型呼吸衰竭的疗效分析[J/CD]. 中华肺部疾病杂志(电子版), 2021, 14(4): 422-426.
2 马 艳, 许淮豫. 时间控制通气护理模式对AECOPD伴呼吸衰竭患者耐受率及焦虑抑郁状态的影响[J]. 现代中西医结合杂志, 2023, 32(3): 406-408, 412.
3 孙艳群, 李梦竹, 汤世琴. 全程多专业合作的护理干预对老年AECOPD患者日常生活能力的影响[J]. 海军医学杂志, 2020, 41(4): 434-438.
4 陈卫华, 李 洁. 新生儿护理预警机制对新生儿黄疸症状改善及家长满意度的影响[J]. 国际护理学杂志, 2021, 40(16): 3054-3057.
5 张 泉, 可珍珍. 全程多维度无盲点护理模式对老年AECOPD合并呼吸衰竭无创机械通气患者压疮风险的影响[J]. 首都食品与医药, 2021, 28(9): 108-109.
6 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 慢性阻塞性肺疾病基层诊疗指南(2018年)[J]. 中华全科医师杂志, 2018, 17(11): 856-870.
7 严重急性低氧性呼吸衰竭急诊治疗专家共识组. 严重急性低氧性呼吸衰竭急诊治疗专家共识[J]. 中华急诊医学杂志, 2018, 27(8): 844-849.
8 Yu Y, Hu L, Chen X, et al. The impact of the predictive nursing education process on degree of comfort and quality of life for patients in the oncology department[J]. Iran J Public Health, 2017, 46(9): 1231-1236.
9 Paneroni M, Simonelli C, Vitacca M, et al. Aerobic exercise training
in very severe chronic obstructive pulmonary disease:a systematic review and meta-analysis[J]. Am J Phys Med Rehabil, 2017, 96(8): 541-548.
10 Zarzycka D, BartońE, MazurA, et al. Socio-demographic and medical factors associated with patients'satisfaction with nursing care and their perception of pain[J]. Ann Agric Environ Med, 2019, 26(2): 298-303.
11 任宝恒, 杨丽娟. 外周血CC16、EOS及CRP水平与慢阻肺急性加重患者病情程度及预后的关系[J]. 中国急救复苏与灾害医学杂志, 2022, 17(12): 1622-1625, 1668.
12 李碧洁, 赵品侠, 单 妍. 罗伊适应模式对COPD急性加重期患者生活质量的影响[J]. 川北医学院学报, 2020, 35(1): 159-162.
13 杨珍娇, 崔妙玲, 张小芳, 等. 慢性阻塞性肺疾病急性加重期患者症状群及其影响因素研究[J]. 护理学杂志, 2020, 35(3): 30-34.
14 张思圆, 张 琴, 蔡宗钰. 时效性激励模式在慢性阻塞性肺疾病急性加重期伴呼吸衰竭患者肺康复护理中的应用效果[J]. 中国医药导报, 2021, 18(31): 180-184.
15 杨立群, 田建梅. 感染预警机制联合多元护理对原发性肾病综合征患儿血清炎性因子及免疫功能的影响[J]. 内蒙古医科大学学报, 2020(S01): 50-54.
16 余金秀, 周 霞, 胡红玲, 等. 基于儿童早期预警评分构建的分级反应策略在儿科普通病房的应用价值研究[J]. 护士进修杂志, 2020, 35(5): 391-394.
17 黄 蓉, 崔尚卿, 陈培珍. 预警机制联合机械辅助排痰在新生儿肺炎治疗中的应用效果[J]. 中西医结合护理(中英文), 2023, 9(3): 163-165.
18 朱红梅. 基于预警机制的护理干预对毛细支气管炎患儿的影响[J]. 蚌埠医学院学报, 2019, 44(8): 1130-1132.
19 梁玲玲, 彭伶丽, 张 欢, 等. 实施预警机制对骨科手术后深静脉血栓形成的影响[J]. 实用骨科杂志, 2019, 25(1):9 3-96.
20 刘莉莉, 董雅倩. 精细化护理对COPD急性加重期合并呼吸衰竭患者各观察指标及护理质量的影响[J]. 贵州医药, 2022, 46(5): 819-820.
21 杜丽娜, 张蓝方, 苏燕胜, 等. 前列腺癌根治术后患者风险预警护理效果研究[J]. 护理管理杂志, 2022, 22(9): 674-677.
22 陈 云, 江 雅, 陈妙霞, 等. 基于风险预警系统理论的护理风险层级管理体系构建及应用[J]. 现代临床护理, 2022, 21(4): 60-65.
23 邬嘉怡, 胡流芳. 危重症机械通气患者精准化分级预警护理干预研究[J]. 护理管理杂志, 2022, 22(6): 446-449, 456.
24 朱 勤, 刘 红. DECAF评分联合红细胞分布宽度预测慢性阻塞性肺疾病急性加重期短期预后[J]. 广西医科大学学报, 2022, 39(7): 1135-1140.
25 杨 莉, 白文娟. 预警护理提高预防重症监护室导管相关感染的效果观察[J]. 中国药物与临床, 2020, 20(9): 1577-1579.
26 李 宁, 李 静, 高 华. 早期预警护理对ICU重症肺炎机械通气患者预后的影响[J]. 临床与病理杂志, 2021, 41(1): 163-168.
27 刘晓红, 李青茵, 徐若琛. 评判性护理联合预警护理在慢性阻塞性肺疾病合并呼吸衰竭患者中的应用效果[J]. 中华现代护理杂志, 2022, 28(31): 4404-4408.
28 刘 俊, 王 颖, 张雪娟, 等. 多维度护理干预在乙型肝炎患者中的应用效果分析[J]. 山西医药杂志, 2021, 50(2): 303-304.
29 胡 兰, 米艳芝, 张 颖. 预警护理模式在肺癌PICC化疗患者中的应用[J]. 中华现代护理杂志, 2022, 28(15): 2048-2051.
30 刘宇莹, 魏向妮, 张晓梅. 经典案例指出下预警护理干预对产妇心理状况、产后并发症发生率的影响[J]. 贵州医药, 2022, 46(12): 2000-2001.
31 刘娟娟, 李志华. 风险预警对无创呼吸机治疗肺心病并发呼吸衰竭的作用[J/CD]. 中华肺部疾病杂志(电子版), 2024, 17(4): 645-647.

备注/Memo

备注/Memo:

基金项目: 陕西省2022年科技计划(2022SF-229)
通信作者: 张 莉, Email: 308201546@qq.com

常用功能

更新日期/Last Update: 2024-12-25