肺部超声评分在神经外科气管切开合并肺部感染患者肺部理疗中的应用  

Application of lung ultrasound score in pulmonary physiotherapy for patients with tracheotomy and pulmonary infection

作　　者：韩江英[1] 胡兵兵[2] 孙亮亮 李成聪 钱卫南 叶雷 HAN Jiangying;HU Bingbing;SUN Liangliang;LI Chengcong;QIAN Weinan;YE Lei(Department of Nursing,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院护理部,安徽合肥230022 [2]安徽医科大学第一附属医院神经外科,安徽合肥230022

出　　处：《皖南医学院学报》2022年第3期299-303,共5页Journal of Wannan Medical College

基　　金：国家自然科学基金青年项目(81901238);安徽省质量工程项目(2020jyxm0927);安徽医科大学第一附属医院急危重症护理专科建设项目(2020JWZZHL-07,2020JWZZHL-09)。

摘　　要：目的:对比肺部超声评分(LUS)引导下肺部理疗与常规肺部理疗对神经外科气管切开合并肺部感染患者的疗效。方法:选取2020年1月~2021年2月安徽医科大学第一附属医院神经外科60例气管切开合并肺部感染的患者作为研究对象,随机分成对照组和观察组各30例,对照组实施常规肺部理疗,观察组实施LUS引导下的肺部理疗。记录两组患者肺部理疗前及理疗7 d后的白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、血气分析、LUS评分、胸片评分、临床肺部感染评分(CPIS)、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及序贯器官衰竭评分(SOFA),并进一步分析LUS与氧合指数、胸片评分、CPIS评分、APACHEⅡ评分、SOFA评分的相关性。结果:两组患者肺部理疗前基线资料差异无统计学意义(P>0.05)。对照组肺部理疗7 d后的WBC、CRP、LUS评分、胸片评分、CPIS评分、APACHEⅡ评分、SOFA评分较理疗前有所改善(P<0.05);观察组肺部理疗7 d后的WBC、CRP、PCT、PaO_(2)、氧合指数、LUS评分、胸片评分、CPIS评分、APACHEⅡ评分、SOFA评分较理疗前有所改善(P<0.05)。与对照组相比,观察组理疗后WBC、CRP、PCT、PaO_(2)、氧合指数、LUS评分、胸片评分、CPIS评分、APACHEⅡ评分、SOFA评分改善较为明显(P<0.05)。LUS与氧合指数呈负相关(r_(s)=-0.784,P<0.01),与胸片评分(r_(s)=0.773)、CPIS评分(r_(s)=0.766)、APACHEⅡ评分(r=0.666)、SOFA评分(r_(s)=0.720)均呈正相关(P<0.01)。结论:LUS引导神经外科气管切开合并肺部感染的患者进行肺部理疗效果显著,值得在临床推广应用。Objective:To compare the efficacy of pulmonary physiotherapy guided by lung ultrasound score(LUS)and conventional pulmonary physiotherapy in patients undergone tracheotomy concomitant with pulmonary infection.Methods:Sixty patients undergoing tracheotomy concomitant with pulmonary infection,treated in our department between January 2020 and February 2021,were included,and randomized to control group and observational group(n=30 in each group).Patients in the control group received simple conventional pulmonary physiotherapy,and those in the observational group were given pulmonary physiotherapy under the guidance of LUS.The clinical indicators,including white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),blood gas analysis results,and scoring on lung ultrasound,chest X-ray,Clinical Pulmonary Infection Scale(CPIS),Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)and Sequential Organ Failure Assessment(SOFA)scale,were maintained in the two groups before and after pulmonary physiotherapy.Then the correlation between LUS and oxygenation index,scoring on chest X-ray,CPIS,APACHEⅡand SOFA were further analyzed.Results:There was no significant difference in baseline data between the two groups of patients before pulmonary physiotherapy(P>0.05).Levels of WBC and CRP as well as scoring on LUS,chest X-ray,CPIS,APACHEⅡand SOFA were improved in the control group 7 days after pulmonary physiotherapy(P<0.05),and improved WBC,CRP,PCT,PaO_(2),oxygenation index,scores of LUS,chest X-ray,CPIS,APACHEⅡand SOFA were also seen in observational group 7 days following pulmonary physiotherapy(P<0.05).WBC,CRP,PCT,PaO_(2),oxygenation index and scoring on LUS,chest X-ray,CPIS,APACHEⅡand SOFA were improved more significantly in the observational group than in the control group after physiotherapy(P<0.05).LUS was negatively correlated with oxygenation index(r_(s)=-0.784,P<0.01),yet positively with scores of chest X-ray(r_(s)=0.773,P<0.01),CPIS(r_(s)=0.766,P<0.01),APACHEⅡ(r=0.666,P<0.01)and SOFA(r_(s)=0.7

关 键 词：肺部超声评分 气管切开 肺部感染 肺部理疗 

分 类 号：R473.6[医药卫生—护理学] R473.3[医药卫生—临床医学]