循证理论支持下综合干预重症肺炎患者的价值及对预防呼吸机相关性肺炎的效果  

Effect of a comprehensive intervention based on evidence-based theory on severe pneumonia and its application value in preventing ventilator-associated pneumonia

作　　者：高春子 夏茂红 耿立惠[1] 马文通 孙海军 GAO Chunzi;XIA Maohong;GENG Lihui(Jiangsu Prouince(Suqian)Hospital,Jiangsu,Suqian 223800,China)

机构地区：[1]江苏省人民医院宿迁医院,223800

出　　处：《河北医药》2024年第24期3791-3794,共4页Hebei Medical Journal

基　　金：宿迁市科技计划(重点研发计划社会发展)项目(编号:SY202217)。

摘　　要：目的研究重症肺炎患者用基于循证理论的综合干预的效果及对预防呼吸机相关性肺炎(VAP)的应用价值。方法选取2022年5月至2023年6月收治的开展机械通气治疗的重症肺炎患者80例,在随机分组法下,将其分为对照组(常规干预)和试验组(基于循证理论的综合干预),每组40例。比较血气指标、口腔清洁度指标、炎性反应指标、呼吸机脱机率、VAP发生率、症状消失时间。结果干预后,试验组SpO_(2)、氧合指数高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05);干预后,试验组牙菌斑指数、BOAS低于对照组,差异有统计学意义(P<0.05);干预后,试验组PCT、CRP、WBC低于对照组,差异有统计学意义(P<0.05);干预后,试验组呼吸机脱机率高于对照组、试验组VAP发生率低于对照组,差异有统计学意义(P<0.05);干预后,试验组咳嗽、喘息、喘鸣音、气促等症状消失时间短于对照组,差异有统计学意义(P<0.05)。结论在重症肺炎患者开展机械通气治疗过程中,配合基于循证理论的综合干预措施,可以在改善血气指标与口腔清洁度的同时降低炎性反应水平,对预防或是减少VAP的发生具有积极作用,值得推崇。Objective To study the effect of a comprehensive intervention based on evidence-based theory on the prevention of ventilator-associated pneumonia(VAP)in patients with severe pneumonia.Methods A total of 80 patients with severe pneumonia undergoing mechanical ventilation from May 2022 to June 2023 were included and randomly divided into the control group(n=40,routine intervention)and experimental group(n=40,comprehensive intervention based on evidence-based theory).Blood gas indexes,oral cleanliness indexes,inflammatory response indexes,weaning off rate,VAP incidence,and symptom resolution time were compared.Results After the intervention,oxygen saturation(SpO_(2))and oxygenation index in the experimental group were significantly higher in the control group,while partial pressure of carbon dioxide(PaCO_(2))was significantly lower(P<0.05).After the intervention,the dental plaque index and the Buccal Oral Assessment System(BOAS)score in the experimental group were significantly lower than those of the control group(P<0.05).After the intervention,procalcitonin(PCT),C-reactive protein(CRP)and white blood cell count(WBC)were significantly lower in the experimental group than those of the control group(P<0.05).After the intervention,significantly higher weaning off rate and lower incidence of VAP were detected in the experimental group than those of the control group(P<0.05).After the intervention,the disappearance time of cough,wheeze,wheezing sounds and shortness of breath in the experimental group was significantly shorter than the control group(P<0.05).Conclusion In the course of mechanical ventilation therapy for severe pneumonia,a comprehensive intervention measures based on evidence-based theory can improve blood gas indexes and oral cleanliness while reducing the level of inflammatory response.It has a positive effect on preventing or reducing the occurrence of VAP,and worthy of commendation.

关 键 词：重症肺炎 循证理论 综合干预 呼吸机相关性肺炎(VAP) 口腔清洁度 炎性反应 

分 类 号：R563.1[医药卫生—呼吸系统]