基于肺部超声引导的护理策略在机械通气患者呼吸管理中的应用  

Application of nursing strategy guided by lung ultrasound in respiratory management of patients with mechanical ventilation

作　　者：曹岚[1] 孙杨[1] 张丽娜[2] 彭倩宜[2] 田盾 石章娥 杨清[2] 中国重症超声研究组 CAO Lan;SUN Yang;ZHANG Lina;PENG Qianyi;TIAN Dun;SHI Zhange;YANG Qing;CCUSG(Teaching and Research Section of Clinical Nursing,Xiangya Hospital,Central South University,National Clinical Research Center for Geriatric Disorders,Changsha,410008,China;不详)

机构地区：[1]中南大学湘雅医院临床护理学教研室,国家老年疾病临床医学研究中心,长沙市410008 [2]中南大学湘雅医院重症医学科,长沙市410008 [3]中南大学湘雅医院康复科,长沙市410008 [4]不详

出　　处：《中国护理管理》2021年第3期331-337,共7页Chinese Nursing Management

基　　金：湖南省自然科学基金(2020JJ5918)。

摘　　要：目的:探讨基于肺部超声引导的护理策略在机械通气患者呼吸管理中的应用效果。方法:选取2018年3月至2019年6月在湖南省长沙市某三级甲等医院重症医学科行机械通气的患者70例,随机分为观察组和对照组各35例。观察组根据肺部超声的结果实施目标导向的综合胸部物理治疗护理策略,对照组采用常规综合胸部物理治疗。比较两组患者肺部超声评分、膈肌功能、氧合指数、生命体征、机械通气时间和ICU住院时间的变化。结果:两组患者的肺部超声评分都呈下降趋势,观察组在入住ICU第3、4、5天肺部超声评分明显低于对照组,膈肌位移在第5天大于对照组,膈肌增厚率在入住ICU第3、4、5天明显高于对照组,两组氧合指数均有明显改善,观察组在入住ICU第4、5天氧合指数明显高于对照组,观察组在入住ICU第3、4、5天呼吸频率低于对照组,在入住ICU第2、3、4、5天经皮动脉血氧饱和度高于对照组,观察组比对照组机械通气时间、ICU住院时间明显缩短,差异有统计学意义(P<0.05),观察组患者的心率和血压与对照组比较差异无统计学意义(P>0.05)。结论:实施基于肺部超声引导的综合胸部物理治疗护理策略可以改善机械通气患者的肺部情况、膈肌功能和氧合,缩短机械通气的时间和ICU住院时间。Objective:To explore the application effect of nursing strategy guided by lung ultrasound in respiratory management of patients with mechanical ventilation.Methods:A total of 70 patients with mechanical ventilation in a Critical Care Medicine Department from March 2018 to June 2019 were selected and randomly divided into observation group and control group,with 35 cases in each group.The control group was treated with comprehensive chest physiotherapy,while the observation group was given the nursing strategy of goal-oriented comprehensive chest physiotherapy according to the results of lung ultrasound.Lung ultrasound score,diaphragm function,oxygenation index,vital signs,duration of mechanical ventilation and length of stay in ICU were compared between the two groups.Results:The lung ultrasound scores of the two groups showed a downward trend.Compared with the control group,the lung ultrasound scores in the observation group were significantly lower than those in the control group on the 3 rd,4 th and 5 th days,and the difference was statistically significant(P<0.05).The diaphragmatic excursion of observation group was higher than that of control group on the 5 th day.The diaphragm thickening fraction of observation group was significantly higher than that of control group on the 3 rd,4 th and 5 th days,and the difference was statistically significant(P<0.05).The oxygenation index of the observation group was significantly higher than that of the control group on the 4 th and 5 th days,and the difference was statistically significant(P<0.05).The respiratory rate in the observation group was lower than that in the control group on the 3 rd,4 th and 5 th days,and the Pulse Oxygen Saturation was higher on the 2 nd,3 rd,4 th and 5 th days,the difference was statistically significant(P<0.05).In terms of duration of mechanical ventilation and length of stay in ICU,the observation group was significantly shorter than the control group,and the difference was statistically significant(P<0.05).There was no statistically d

关 键 词：超声 胸部物理治疗 机械通气 呼吸治疗 危重症 

分 类 号：R47[医药卫生—护理学]