颈髓损伤机械通气患者肺康复方案的构建与临床应用研究
发布时间：2018-07-26 11:23
【摘要】：目的以循证医学为手段,回顾国内外颈髓损伤(Cervical Spinal Cord Injury,CSCI)机械通气(Meachanical Ventilation,MV)患者肺康复(Pulmonary Rehabilitation,PR)措施的研究进展,对CSCI机械通气患者肺康复护理有关信息进行全面收集,了解目前患者肺康复训练现状。以现况研究为依据,经过文献回顾、专家会议法结合临床实际构建科学、规范、实用的CSCI机械通气患者肺康复方案。并将方案运用到临床进行应用效果的研究,以期为临床康复护理提供指导,降低肺部感染发生率、减少颈髓损伤患者使用呼吸机时间和住院时间,节省医疗开支,使CSCI患者生活质量得到提高,直至患者全面康复。方法1.运用回顾性研究法调查CSCI机械通气患者康复护理情况:应用电子病历信息系统,收集2015年1月至2015年12月入住重庆市某家三级甲等综合医院ICU中华CSCI机械通气患者的病例共42例,并对信息进行收集、整理、归纳,将所得到的数据进行描述性分析,主要了解当前CSCI机械通气患者肺康复训练现状。2.运用文献回顾和专家会议法进行肺康复方案的构建:(1)CSCI机械通气患者临床资料的回顾性分析,找出康复护理措施中的不足之处;(2)查阅并分析CSCI机械通气患者肺康复与护理有关的指南和文献,重点选用指南中强烈推荐的证据内容和高质量RCT研究确定基本内容,结合临床中调查回馈信息确立肺康复训练方案草案;(3)召开专家会议,讨论CSCI机械通气患者CSCI肺功能康复训练方案的基本内容,结合专家意见进行整理和修订,确立CSCI机械通气患者肺康复训练的正式文本。3.运用类实验研究法进行肺康复方案临床效果的验证:选取2015年1月~12月颈髓损伤患者作为对照组,对照组采用常规护理措施;选取2016年1月~2016年12月颈髓损伤患者作为治疗组,采取早期分级综合性肺康复方案,比较两组患者在使用呼吸机使用时间、总住院时间、肺部感染率的差异。结果1.在42例临床病例回顾性分析发现,CSCI患者的平均年龄为51.14±12.71岁,受伤高峰年龄为42岁~59岁。其中男性患者32例,占76.19%,女性患者为10例,占23.81%,男女患者比例为3.2:1。医疗费用支付方式:公费医疗1例,自费医疗4例,医疗保险23例,商业保险12例,其它方式2例。CSCI患者受伤原因:交通事故创伤比例最高,其中以颈髓神经节段C3~C6居多,且受伤程度在A、B级的占55%。对CSCI机械通气患者的康复护理措施中,有几项薄弱点:(1)没有康复实施时间,可能导致患者失去最佳的康复时机;(2)缺乏专业的团队做指导;(3)康复目标不明确;(4)缺乏评估机制;(5)康复措施内容单一;(6)CSCI机械通气患者康复措施的实施者较为单一。以上薄弱环节容易导致CSCI机械通气患者发生一系列并发症,本组患者肺部的感染率高达76.19%。肺部感染的发生导致患者呼吸机使用时间、总住院时间延长,从而降低患者的生存率与生活质量。2.在方案构建研究中,以循证医学为手段,文献分析结果为依据,结合临床实际,通过专家会议法制定了CSCI肺康复方案的正式文本。该方案主要包括肺康复方案基本资料、评估分级资料、运动训练内容、气道管理和呼吸肌训练内容、其他护理措施、备注6个部分。3.在临床效果验证的研究中,将方案应用于临床进行类实验研究,结果显示,对照组机械通气时间(13.98±11.11)天,治疗组机械通气时间(7.23±4.94)天;对照组总住院时间(25.00±17.95)天,治疗组总住院时间(16.70±7.21)天;对照组肺部感染人数31例(感染率76.19%),治疗组肺部感染人数26例(感染率52.38%),比较两组机械通气时间、总住院时间、肺部感染率,差异均有统计学意义(P0.01)。结论以循证医学作为手段,以临床目前康复现况为参考,结合专家的意见制定的CSCI机械通气患者肺康复训练方案,有助于降低患者的肺部感染率,缩短呼吸机的使用时间和总住院时间,具有较好的实效性和临床推广价值。
[Abstract]:Objective to review the research progress of the pulmonary rehabilitation (Pulmonary Rehabilitation, PR) measures for patients with Cervical Spinal Cord Injury (CSCI) mechanical ventilation (Meachanical Ventilation, MV) with evidence-based medicine, and to collect the relevant information on lung rehabilitation nursing for patients with CSCI mechanical ventilation and to understand the current patients' lung rehabilitation training. Practice status. Based on current situation research, through literature review, expert meeting method combined with clinical practice to construct a scientific, standardized and practical lung rehabilitation program for patients with mechanical ventilation in CSCI, and apply the scheme to clinical application results, in order to provide guidance for clinical rehabilitation nursing, reduce the incidence of pulmonary infection and reduce cervical spinal cord injury. The people used the time of ventilator and the time of hospitalization to save the medical expenses and improve the quality of life of the CSCI patients until the patients were fully rehabilitated. Method 1. the retrospective study method was used to investigate the rehabilitation nursing of patients with CSCI mechanical ventilation: the electronic medical record information system was applied to collect a class of three grade A in Chongqing from January 2015 to December 2015. A total of 42 cases of ICU Chinese CSCI mechanical ventilation patients in general hospital were collected, collated, summed up, and the obtained data were descriptive analysis. The current status of pulmonary rehabilitation training for patients with CSCI mechanical ventilation was mainly understood by.2. literature review and expert meeting method for the construction of lung rehabilitation program: (1) CSCI mechanical ventilation patients. Retrospective analysis of clinical data to find out the inadequacies in rehabilitation nursing measures; (2) consult and analyze the guidelines and literature related to lung rehabilitation and nursing in CSCI patients with mechanical ventilation, focus on the evidences recommended in the guide and the high quality RCT study to determine the basic content, and to establish the pulmonary rehabilitation training with the feedback information in the clinical investigation. Draft plan; (3) convening an expert meeting to discuss the basic contents of CSCI lung function rehabilitation training program for patients with mechanical ventilation in CSCI, collating and revising with expert opinion, establishing the formal text of lung rehabilitation training for patients with CSCI mechanical ventilation by using the class experiment study method to verify the clinical effect of lung rehabilitation program: select January 2015 ~12 The patients with cervical spinal cord injury were used as the control group and the control group adopted routine nursing measures, and the patients with cervical spinal cord injury in December ~2016 year in January 2016 were selected as the treatment group, and the early stage comprehensive lung rehabilitation program was adopted to compare the difference of the time of use of ventilator, the time of total hospitalization and the rate of pulmonary infection in the two groups. Results 1. in 42 cases of clinical case return. The average age of CSCI patients was 51.14 + 12.71 years old and the peak age of the injury was 42 years old ~59 years, of which 32 were male, 76.19%, 10 for women, 23.81%, and 23.81% for male and female patients: 1 for public health care, 4 for medical treatment, 23 medical insurance, 12 in commercial insurance, and 2 in other ways. The injury causes of.CSCI patients: the highest proportion of traffic accident trauma, among them the majority of the cervical spinal ganglion segment C3~C6, and the degree of injury in the A, the B class 55%. for the CSCI mechanical ventilation patients' rehabilitation nursing measures, there are several weak points: (1) no rehabilitation time, may cause the patients to lose the best time for rehabilitation; (2) lack of professional team do Guidance; (3) the objective of rehabilitation was not clear; (4) lack of evaluation mechanism; (5) the content of rehabilitation measures was single; (6) the implementation of the rehabilitation measures for CSCI mechanical ventilation patients was relatively simple. The above weak links were easy to lead to a series of complications in the patients with CSCI mechanical ventilation, and the rate of pulmonary infection in this group was as high as the occurrence of 76.19%. pulmonary infection. The time of use of ventilator and the prolongation of total length of hospital stay, thus reducing the survival rate and quality of life of the patients, and reducing the survival rate and quality of life of the patients with.2. in the project construction study, based on evidence-based medicine, based on the results of literature analysis, and combining the clinical practice, the formal text of the CSCI lung rehabilitation program is established through the expert meeting legal system. The scheme mainly includes the basic funds of the lung rehabilitation program. Materials, evaluation classification data, exercise training content, airway management and respiratory muscle training content, other nursing measures, 6 parts of.3. in clinical effect validation study, the scheme was applied to clinical study, the results showed that the control group mechanical ventilation time (13.98 + 11.11) days, the treatment group mechanical ventilation time (7.23 + 4.94) days; The total hospitalization time of the control group (25 + 17.95) days, the total hospitalization time of the treatment group (16.70 + 7.21) days, the number of pulmonary infection in the control group 31 cases (infection rate 76.19%), the number of pulmonary infection in the treatment group 26 cases (infection rate 52.38%), compared the time of mechanical ventilation in the two groups, the total hospitalization time, the pulmonary infection rate, the difference was statistically significant (P0.01). Conclusion the results were evidence-based medicine. It is helpful to reduce the rate of pulmonary infection, shorten the time of the use of the ventilator and the total time of hospitalization, which is of good effectiveness and clinical value. As a means, as a means, with the current status of the clinical rehabilitation as a reference, the lung rehabilitation training program of CSCI mechanical ventilation patients combined with the opinions of the experts is helpful to reduce the rate of pulmonary infection in the patients, shorten the use time of the ventilator and the total time of hospitalization.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6
本文编号：2145852
[Abstract]:Objective to review the research progress of the pulmonary rehabilitation (Pulmonary Rehabilitation, PR) measures for patients with Cervical Spinal Cord Injury (CSCI) mechanical ventilation (Meachanical Ventilation, MV) with evidence-based medicine, and to collect the relevant information on lung rehabilitation nursing for patients with CSCI mechanical ventilation and to understand the current patients' lung rehabilitation training. Practice status. Based on current situation research, through literature review, expert meeting method combined with clinical practice to construct a scientific, standardized and practical lung rehabilitation program for patients with mechanical ventilation in CSCI, and apply the scheme to clinical application results, in order to provide guidance for clinical rehabilitation nursing, reduce the incidence of pulmonary infection and reduce cervical spinal cord injury. The people used the time of ventilator and the time of hospitalization to save the medical expenses and improve the quality of life of the CSCI patients until the patients were fully rehabilitated. Method 1. the retrospective study method was used to investigate the rehabilitation nursing of patients with CSCI mechanical ventilation: the electronic medical record information system was applied to collect a class of three grade A in Chongqing from January 2015 to December 2015. A total of 42 cases of ICU Chinese CSCI mechanical ventilation patients in general hospital were collected, collated, summed up, and the obtained data were descriptive analysis. The current status of pulmonary rehabilitation training for patients with CSCI mechanical ventilation was mainly understood by.2. literature review and expert meeting method for the construction of lung rehabilitation program: (1) CSCI mechanical ventilation patients. Retrospective analysis of clinical data to find out the inadequacies in rehabilitation nursing measures; (2) consult and analyze the guidelines and literature related to lung rehabilitation and nursing in CSCI patients with mechanical ventilation, focus on the evidences recommended in the guide and the high quality RCT study to determine the basic content, and to establish the pulmonary rehabilitation training with the feedback information in the clinical investigation. Draft plan; (3) convening an expert meeting to discuss the basic contents of CSCI lung function rehabilitation training program for patients with mechanical ventilation in CSCI, collating and revising with expert opinion, establishing the formal text of lung rehabilitation training for patients with CSCI mechanical ventilation by using the class experiment study method to verify the clinical effect of lung rehabilitation program: select January 2015 ~12 The patients with cervical spinal cord injury were used as the control group and the control group adopted routine nursing measures, and the patients with cervical spinal cord injury in December ~2016 year in January 2016 were selected as the treatment group, and the early stage comprehensive lung rehabilitation program was adopted to compare the difference of the time of use of ventilator, the time of total hospitalization and the rate of pulmonary infection in the two groups. Results 1. in 42 cases of clinical case return. The average age of CSCI patients was 51.14 + 12.71 years old and the peak age of the injury was 42 years old ~59 years, of which 32 were male, 76.19%, 10 for women, 23.81%, and 23.81% for male and female patients: 1 for public health care, 4 for medical treatment, 23 medical insurance, 12 in commercial insurance, and 2 in other ways. The injury causes of.CSCI patients: the highest proportion of traffic accident trauma, among them the majority of the cervical spinal ganglion segment C3~C6, and the degree of injury in the A, the B class 55%. for the CSCI mechanical ventilation patients' rehabilitation nursing measures, there are several weak points: (1) no rehabilitation time, may cause the patients to lose the best time for rehabilitation; (2) lack of professional team do Guidance; (3) the objective of rehabilitation was not clear; (4) lack of evaluation mechanism; (5) the content of rehabilitation measures was single; (6) the implementation of the rehabilitation measures for CSCI mechanical ventilation patients was relatively simple. The above weak links were easy to lead to a series of complications in the patients with CSCI mechanical ventilation, and the rate of pulmonary infection in this group was as high as the occurrence of 76.19%. pulmonary infection. The time of use of ventilator and the prolongation of total length of hospital stay, thus reducing the survival rate and quality of life of the patients, and reducing the survival rate and quality of life of the patients with.2. in the project construction study, based on evidence-based medicine, based on the results of literature analysis, and combining the clinical practice, the formal text of the CSCI lung rehabilitation program is established through the expert meeting legal system. The scheme mainly includes the basic funds of the lung rehabilitation program. Materials, evaluation classification data, exercise training content, airway management and respiratory muscle training content, other nursing measures, 6 parts of.3. in clinical effect validation study, the scheme was applied to clinical study, the results showed that the control group mechanical ventilation time (13.98 + 11.11) days, the treatment group mechanical ventilation time (7.23 + 4.94) days; The total hospitalization time of the control group (25 + 17.95) days, the total hospitalization time of the treatment group (16.70 + 7.21) days, the number of pulmonary infection in the control group 31 cases (infection rate 76.19%), the number of pulmonary infection in the treatment group 26 cases (infection rate 52.38%), compared the time of mechanical ventilation in the two groups, the total hospitalization time, the pulmonary infection rate, the difference was statistically significant (P0.01). Conclusion the results were evidence-based medicine. It is helpful to reduce the rate of pulmonary infection, shorten the time of the use of the ventilator and the total time of hospitalization, which is of good effectiveness and clinical value. As a means, as a means, with the current status of the clinical rehabilitation as a reference, the lung rehabilitation training program of CSCI mechanical ventilation patients combined with the opinions of the experts is helpful to reduce the rate of pulmonary infection in the patients, shorten the use time of the ventilator and the total time of hospitalization.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6
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