阶梯式呼吸管理护理策略在感染性休克合并急性肺损伤患者中的应用效果

doi:10.3969/j.issn.1000-8535.2023.04.015

广州医药 ›› 2023, Vol. 54 ›› Issue (4): 87-90.DOI: 10.3969/j.issn.1000-8535.2023.04.015

阶梯式呼吸管理护理策略在感染性休克合并急性肺损伤患者中的应用效果

罗少颜, 冼燕珊, 马洁葵, 罗瑞平, 冼敏玲

佛山市第一人民医院（中山大学附属佛山医院）重症医学科（佛山 528000）

收稿日期:2022-06-24 出版日期:2023-04-20 发布日期:2023-05-18

Effect of stepwise respiratory management nursing strategy on patients with septic shock complicated with acute lung injury

LUO Shaoyan, XIAN Yanshan, MA Jiekui, LUO Ruiping, XIAN Minling

Department of Critical Medicine,Foshan First People's Hospital（Foshan Hospital Affiliated to Sun Yat-sen University）,Foshan 528000,China

Received:2022-06-24 Online:2023-04-20 Published:2023-05-18

摘要/Abstract

摘要： 目的观察阶梯式呼吸管理策略在改善感染性休克伴急性肺损伤（ALI）患者中的价值。方法纳入我院2019年1月—2020年12月收治的感染性休克伴ALI患者共146例为研究对象,数字表法随机分为观察组（73例）与对照组（73例）。对照组常规护理方案,观察组阶梯式呼吸管理,对比干预前后患者心肺功能的差异。结果观察组平均动脉压、PaCO₂水平低于对照组,心脏指数、中心静脉压、血管外肺水指数、PaO₂与氧合指数高于对照组（P<0.05）;观察组复苏成功率与临床总有效率高于对照组,复苏时间与呼吸平稳时间低于对照组（P<0.05）;观察组气管切开率、有创呼吸机使用率及呼吸机相关性肺炎与气道并发症发生率均低于对照组（P<0.05）。结论感染性休克并急性肺损伤患者建立阶梯化呼吸管理策略能够显著改善患者的心肺功能,提高临床复苏效果,降低相关并发症风险。

关键词: 感染性休克, 急性肺损伤, 阶梯式呼吸管理, 心肺功能

Abstract: Objective To observe the value of stepwise respiratory management strategy in improving patients with septic shock and acute lung injury（ALI）．Methods A total of 146 patients with septic shock and ALI treated in our hospital from January 2019 to December 2020 were included as the research objects．They were randomly divided into observation group（73 cases）and control group（73 cases）by digital table method．The control group received routine nursing plan,and the observation group received stepwise respiratory management．The differences of cardiopulmonary function before and after the intervention were compared．Results The levels of mean arterial pressure,PaCO₂in the observation group were significantly lower than those in the control group,cardiac index,central venous pressure,extravascular lung water index,PaO₂and oxygenation index in the observation group were significantly higher than those in the control group（P<0.05）．The success rate of resuscitation and total clinical effective rate in the observation group were significantly higher than those in the control group,and the resuscitation time and respiratory stability time in the observation group were significantly shorter than those in the control group（P<0.05）．The tracheotomy rate,the rate of using invasive ventilator and the incidence of ventilator associated pneumonia and airway complications in the observation group were lower than those in the control group（P<0.05）．Conclusions The establishment of stepwise respiratory management strategy in patients with septic shock and ALI can significantly improve their cardiopulmonary function,improve the effect of clinical resuscitation and reduce the risk of related complications.

Key words: septic shock, acute lung injury, stepwise respiratory management, cardiopulmonary function

罗少颜, 冼燕珊, 马洁葵, 罗瑞平, 冼敏玲. 阶梯式呼吸管理护理策略在感染性休克合并急性肺损伤患者中的应用效果[J]. 广州医药, 2023, 54(4): 87-90.

LUO Shaoyan, XIAN Yanshan, MA Jiekui, LUO Ruiping, XIAN Minling. Effect of stepwise respiratory management nursing strategy on patients with septic shock complicated with acute lung injury[J]. Guangzhou Medical Journal, 2023, 54(4): 87-90.

参考文献

[1] 徐潜,林海,姚明明,等.感染性休克患者预后的危险因素分析[J].中华保健医学杂志,2020,22(4):421-423.
[2] 叶龙强,董绉绉,石林惠,等.重症监护病房老年感染性休克患者的预后危险因素分析[J].中华临床感染病杂志,2019(3):192-196.
[3] 黄晓军,陈茜圆,任卓超,等.N-乙酰半胱氨酸对感染性休克小鼠肺损伤保护作用的研究[J].浙江医学,2021,43(3):260-262,267.
[4] 郭平,李军,汪勇.急危重症患者急诊抢救使用呼吸阶梯性治疗方法的疗效研究[J].世界复合医学,2021,7(1):83-85.
[5] 贾文华,石印服,高明,等.加味补中益气汤联合氨溴索用于呼吸支持治疗临床观察[J].中国药业,2020,29(18):91-93.
[6] 中华医学会重症医学分会.急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)[C].中华医学会重症医学基本理论与基本技能研讨会论文集. 2007:50-61.
[7] 黄伟,万献尧.2013版严重全身性感染和感染性休克处理指南解读[J].中国实用内科杂志,2013,33(11):866-868.
[8] 崔益明,徐小良,楼炳恒.动态监测氧合指数和降钙素原评估感染性休克合并急性呼吸窘迫综合征预后的应用价值[J].中国卫生检验杂志,2019,29(12):1506-1509.
[9] 陈牡丹,陈健良,王金柱,等.C-反应蛋白与血清白蛋白比值预测感染性休克患者发生急性呼吸窘迫综合征的价值分析[J].中国急救医学,2018,38(2):164-168.
[10] 孙丽娟,祁荣,范菁菁,等.感染性休克并发急性呼吸窘迫综合征患者肺水肿指数变化及其意义[J].山东医药,2018,58(40):48-50.
[11] 王玉如,何英,周丽华,等.心脏介入诊疗术中并发急性心血管事件患者行呼吸阶梯化管理的护理[J].解放军护理杂志,2015,32(4):52-54.
[12] 李晓东,李甜,郝春艳,等.自适应支持通气+智能模式对老年COPD合并呼吸衰竭患者呼吸力学的影响[J].中国老年学杂志,2020,40(14):2979-2981.
[13] 代涛,张秀春,孙颖,等.适应性支持通气对急诊老年呼吸衰竭患者呼吸力学指标的影响[J].中国老年学杂志,2018,38(2):386-388.
[14] 王敏,尚福泰,臧奎,等.呼吸阶梯化管理在救治急性肺损伤中的安全性以及有效性分析[J].现代医学,2018,46(2):218-221.
[15] 吴玉丹,梁梅兰,吴美景,等.呼吸阶梯化管理在感染性休克合并急性肺损伤患者中的应用分析[J].中华危重病急救医学,2021,33(3):334-337.

阶梯式呼吸管理护理策略在感染性休克合并急性肺损伤患者中的应用效果

Effect of stepwise respiratory management nursing strategy on patients with septic shock complicated with acute lung injury

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