集束化护理联合中药肠道去污在严重骨创伤后ARDS患者治疗中的应用评价  

Cluster of Intestinal Decontamination Evaluate Care Combined with Traditional Chinese Therapy of Patients with ARDS and Efficacy in Severe Post-traumatic Bone

作　　者：焦瑞娜[1] 杨铁柱[1] 杨晓静[1] 杨玉霞[1] 李良业[1] 

机构地区：[1]河南省洛阳正骨医院河南省骨科医院,河南洛阳471002

出　　处：《中医药临床杂志》2016年第9期1319-1323,共5页Clinical Journal of Traditional Chinese Medicine

基　　金：河南省中医药科学研究专项课题(2013zy02010)

摘　　要：目的观察集束化护理策略联合中药肠道去污疗法在严重骨创伤后急性呼吸窘迫综合症(ARDS)患者临床治疗中的应用及疗效评价。方法 150例患者随机平均分入A组、B组、C组。A组采用西医常规护理及治疗,B组采用集束化护理联合西医常规治疗,C组在B组治疗方案上加用中药肠道去污疗法。观察3组患者治疗前及治疗后7d吸氧浓度(FiO_2)、动脉氧分压(PaO_2)、氧和指数(PaO_2/FiO_2)、潮气量(Vt)的变化,呼吸机相关性肺炎(VAP)的发生率,ICU总费用、入住和使用呼吸机时间,口腔、PICC、中心静脉置管细菌培养阳性率,以及60日死亡率和压疮发生率、非计划拔管率、误吸发生率。结果治疗后7d,C组FiO_2、PaO_2、PaO_2/FiO_2、Vt较A、B两组明显改善,B组与A组对比有统计学意义(P<0.05)。B、C两组于VAP发生率、各细菌学培养阳性率、60日死亡率比较中无明显差异(P>0.05),与A组比较有统计学意义(P<0.05)。C组ICU总费用、入住和使用呼吸机时间较A、B两组存在统计学意义(P<0.05),B组与A组对比有明显差异(P<0.05)。结论集束化护理策略联合中药肠道去污与西医常规治疗严重骨创伤后ARDS,能有效改善患者通气功能,降低VAP发生率、死亡率以及病菌感染风险,缩短ICU入住及呼吸机使用时间,较常规治疗护理更经济,操作性强,依从性更佳。Objective to observe cluster nursing strategies combined traditional Chinese medicine （ TCM ） bowel decontamination treatment in severe bone trauma patients with acute respiratory distress syndrome （ ARDS ） after the application of the clinical treatment and curative effect evaluation.Methods 150 patients were randomized in group A, group B and group C.A group with western medicine routine nursing and treatment, B group use cluster nursing with conventional western medicine therapy, group C in group B with traditional Chinese medicine treatment of intestinal decontamination treatment.Observe three groups of patients before and after the treatment 7 d oxygen concentration FiO2 ）, the arterial oxygen partial pressure （ PaO2 ）, oxygen and index （ PaO2 / FiO2 ）, the changes of tidal volume Vt ）, the incidence of ventilator associated pneumonia （ VAP ）, the total cost in the ICU, check-in and using breathing machine time, oral cavity, PICC, center venipuncture germicuhure positive rate, mortality and the incidence of pressure ulcers and 60 day, unplanned extubation rate, incidence of aspiration.Results 7 d aftertreatment, the group C FiO2, PaO/, PaO2 / FiO2, Vt obviously improved compared with A, B two groups, group B compared with group A with statistical significance （ P 〈 0.05 ）.B and C in the two groups in the incidence of VAP, the culture positive rate of bacteriology, mortality is 60 days of no significant difference （ P 〉 0.05 ）, compared with group A （P 〈 0.05 ）.Total cost in the ICU, in group C and using breathing machine time, compared with A, B two groups had statistical significance （ P 〈 0.05 ）, group B compared with group A had obvious difference （ P 〈 0.05 ） .Conclusion cluster nursing strategies combined traditional Chinese medicine （ TCM ） intestinal decontamination with conventional western medicine to treat severe ARDS after bone trauma, can effectively improve ventilation function of patients, reduce the incidence of VAP, mortality and pat

关 键 词：集束化护理策略 中药肠道去污 通腑净化汤 骨创伤 ARDS 

分 类 号：R47[医药卫生—护理学]