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

发布时间：2018-12-17 06:34

【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(P0.05)。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(P0.05),与A组比较有统计学意义(P0.05)。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(P0.05),B组与A组对比有明显差异(P0.05)。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。
[Abstract]:Objective to observe the clinical application and evaluation of cluster nursing strategy combined with traditional Chinese medicine for intestinal decontamination in patients with acute respiratory distress syndrome (ARDS) after severe bone trauma. Methods 150 patients were randomly divided into group A, group B and group C. Group A was treated with routine western medicine, group B was treated with cluster nursing combined with routine western medicine, group C was treated with traditional Chinese medicine for intestinal decontamination. The changes of oxygen concentration (FiO_2), arterial partial pressure of oxygen (PaO_2), oxygen and index (PaO_2/FiO_2), tidal volume (Vt) and the incidence of ventilator-associated pneumonia (VAP) were observed before and 7 days after treatment. The total cost of ICU, the time of admission and use of ventilator, the positive rate of bacterial culture in oral cavity and central venous tube of PICC, the death rate of 60 days and the incidence of pressure sore, unplanned extubation rate and missuction rate. Results 7 days after treatment, FiO_2,PaO_2,PaO_2/FiO_2,Vt in group C was significantly improved than that in group A (P 0.05). The incidence of VAP in group B was significantly higher than that in group A (P0.05), and the positive rate of bacterial culture in group B was higher than that in group A (P 0.05). There was no significant difference in 60-day mortality (P0.05), but there was significant difference between group A and group A (P0.05). (P0.05) the total cost of ICU, the time of stay and use of ventilator in). C group were significantly higher than those in group A (P0.05), and there was no significant difference between group A and group A (P0.05). There was significant difference between group B and group A (P0.05). Conclusion the cluster nursing strategy combined with traditional Chinese medicine for intestinal decontamination and routine western medicine in the treatment of ARDS, after severe bone trauma can effectively improve the ventilation function of patients, reduce the incidence of VAP, mortality and the risk of bacterial infection, shorten the duration of ICU stay and ventilator use. Compared with conventional treatment and nursing, it is more economical, more operable and more compliant.
【作者单位】：河南省洛阳正骨医院河南省骨科医院;
【基金】：河南省中医药科学研究专项课题(2013zy02010)
【分类号】：R473.6

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