頸髓損傷機械通氣患者肺康復(fù)方案的構(gòu)建與臨床應(yīng)用研究
發(fā)布時間：2018-07-26 11:23
【摘要】：目的以循證醫(yī)學為手段,回顧國內(nèi)外頸髓損傷(Cervical Spinal Cord Injury,CSCI)機械通氣(Meachanical Ventilation,MV)患者肺康復(fù)(Pulmonary Rehabilitation,PR)措施的研究進展,對CSCI機械通氣患者肺康復(fù)護理有關(guān)信息進行全面收集,了解目前患者肺康復(fù)訓(xùn)練現(xiàn)狀。以現(xiàn)況研究為依據(jù),經(jīng)過文獻回顧、專家會議法結(jié)合臨床實際構(gòu)建科學、規(guī)范、實用的CSCI機械通氣患者肺康復(fù)方案。并將方案運用到臨床進行應(yīng)用效果的研究,以期為臨床康復(fù)護理提供指導(dǎo),降低肺部感染發(fā)生率、減少頸髓損傷患者使用呼吸機時間和住院時間,節(jié)省醫(yī)療開支,使CSCI患者生活質(zhì)量得到提高,直至患者全面康復(fù)。方法1.運用回顧性研究法調(diào)查CSCI機械通氣患者康復(fù)護理情況:應(yīng)用電子病歷信息系統(tǒng),收集2015年1月至2015年12月入住重慶市某家三級甲等綜合醫(yī)院ICU中華CSCI機械通氣患者的病例共42例,并對信息進行收集、整理、歸納,將所得到的數(shù)據(jù)進行描述性分析,主要了解當前CSCI機械通氣患者肺康復(fù)訓(xùn)練現(xiàn)狀。2.運用文獻回顧和專家會議法進行肺康復(fù)方案的構(gòu)建:(1)CSCI機械通氣患者臨床資料的回顧性分析,找出康復(fù)護理措施中的不足之處;(2)查閱并分析CSCI機械通氣患者肺康復(fù)與護理有關(guān)的指南和文獻,重點選用指南中強烈推薦的證據(jù)內(nèi)容和高質(zhì)量RCT研究確定基本內(nèi)容,結(jié)合臨床中調(diào)查回饋信息確立肺康復(fù)訓(xùn)練方案草案;(3)召開專家會議,討論CSCI機械通氣患者CSCI肺功能康復(fù)訓(xùn)練方案的基本內(nèi)容,結(jié)合專家意見進行整理和修訂,確立CSCI機械通氣患者肺康復(fù)訓(xùn)練的正式文本。3.運用類實驗研究法進行肺康復(fù)方案臨床效果的驗證:選取2015年1月~12月頸髓損傷患者作為對照組,對照組采用常規(guī)護理措施;選取2016年1月~2016年12月頸髓損傷患者作為治療組,采取早期分級綜合性肺康復(fù)方案,比較兩組患者在使用呼吸機使用時間、總住院時間、肺部感染率的差異。結(jié)果1.在42例臨床病例回顧性分析發(fā)現(xiàn),CSCI患者的平均年齡為51.14±12.71歲,受傷高峰年齡為42歲~59歲。其中男性患者32例,占76.19%,女性患者為10例,占23.81%,男女患者比例為3.2:1。醫(yī)療費用支付方式:公費醫(yī)療1例,自費醫(yī)療4例,醫(yī)療保險23例,商業(yè)保險12例,其它方式2例。CSCI患者受傷原因:交通事故創(chuàng)傷比例最高,其中以頸髓神經(jīng)節(jié)段C3~C6居多,且受傷程度在A、B級的占55%。對CSCI機械通氣患者的康復(fù)護理措施中,有幾項薄弱點:(1)沒有康復(fù)實施時間,可能導(dǎo)致患者失去最佳的康復(fù)時機;(2)缺乏專業(yè)的團隊做指導(dǎo);(3)康復(fù)目標不明確;(4)缺乏評估機制;(5)康復(fù)措施內(nèi)容單一;(6)CSCI機械通氣患者康復(fù)措施的實施者較為單一。以上薄弱環(huán)節(jié)容易導(dǎo)致CSCI機械通氣患者發(fā)生一系列并發(fā)癥,本組患者肺部的感染率高達76.19%。肺部感染的發(fā)生導(dǎo)致患者呼吸機使用時間、總住院時間延長,從而降低患者的生存率與生活質(zhì)量。2.在方案構(gòu)建研究中,以循證醫(yī)學為手段,文獻分析結(jié)果為依據(jù),結(jié)合臨床實際,通過專家會議法制定了CSCI肺康復(fù)方案的正式文本。該方案主要包括肺康復(fù)方案基本資料、評估分級資料、運動訓(xùn)練內(nèi)容、氣道管理和呼吸肌訓(xùn)練內(nèi)容、其他護理措施、備注6個部分。3.在臨床效果驗證的研究中,將方案應(yīng)用于臨床進行類實驗研究,結(jié)果顯示,對照組機械通氣時間(13.98±11.11)天,治療組機械通氣時間(7.23±4.94)天;對照組總住院時間(25.00±17.95)天,治療組總住院時間(16.70±7.21)天;對照組肺部感染人數(shù)31例(感染率76.19%),治療組肺部感染人數(shù)26例(感染率52.38%),比較兩組機械通氣時間、總住院時間、肺部感染率,差異均有統(tǒng)計學意義(P0.01)。結(jié)論以循證醫(yī)學作為手段,以臨床目前康復(fù)現(xiàn)況為參考,結(jié)合專家的意見制定的CSCI機械通氣患者肺康復(fù)訓(xùn)練方案,有助于降低患者的肺部感染率,縮短呼吸機的使用時間和總住院時間,具有較好的實效性和臨床推廣價值。
[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.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.6
本文編號：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.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.6
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