精细化护理干预在无创正压通气治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭中的效果观察

目的 探讨精细化护理干预在BiPAP呼吸机治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭中的效果.方法 选择符合入选标准诊断的AECOPD合并呼吸衰竭患者67例,按照入院时采用的护理方式的不同,分为对照组以及观察组.两组均予以解痉平喘、化痰、抗感染、纠正酸碱失衡、维持内环境稳定、营养支持以及使用BiPAP呼吸机,对照组采用常规护理,观察组采用精细化护理干预.比较两组患者的治疗前后的动脉血气指标,治疗期间的不良反应发生情况以及呼吸机治疗的耐受情况等.结果 两组患者治疗后酸碱度(pH)、氧分压p(O2)]、二氧化碳分压P(CO2)]、氧饱和度(SaO2)等各项动脉血气指标均较治疗前改善(P＜0.05).观察组治疗后动脉血p(O2)及SaO2治疗后均较对照组治疗后升高(P＜0.05),而p(CO2)显著降低(P＜0.05).观察组呼吸机治疗总耐受率为94.29％高于对照组84.38％的总耐受率(P＜0.05).观察组在呼吸机治疗期间,误吸、吸入性肺炎以及口咽不适的发生例数发生率低于对照组(P＜0.05).结论 精细化护理干预能显著改善BiPAP呼吸机治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭的通气功能,提高呼吸机耐受率,降低治疗期间的不良反应发生,有助于疾病的恢复.

Effect observation of elaborating nursing intervention in patients with chronic obstructive pulmonary disease at acute aggravating period combination Respiratory Failure with BiPAP treatment

Objective To explore the effect of elaborating nursing intervention in patients with chronic obstructive pulmonary disease at acute exacerbation period (AECOPD) combined with respiratory failure treated with BiPAP. Methods Sixty-seven patients of AECOPD combined with respiratory failure in conformity to criteria for the diagnosis were chosen and assigned into observation group and control group according to the different nursing care on admission.Both groups had spasmolysis and asthma relief,phlegm resolving,anti-infection,acid-base imbalance correction,a stable internal environment maintainence,nutritional support,and use of BiPAP ventilator.The control group used conventional nursing care,while the observation group adopted elaborating nursing intervention.Comparison was made of the index of arterial blood gas before and after the treatment of two groups,the cases of adverse reactions during treatment as well as the tolerance of the ventilator therapy. Results The arterial blood gas indexes such as pH value (pH),partial pressure of oxygen p(O₂)],partial pressure of carbon dioxide p(CO₂)] and oxygen saturation (SaO₂) in both groups were improved after treatment (P<0.05).Arterial blood p(O₂) and SaO₂ in observation group was significantly higher than those in the control group after the treatment (P<0.05),while p(CO₂) was significantly lower (P<0.05).The total tolerance rate in observation group was 94.29%,significantly higher than 84.38% in control group (P<0.05).The cases of aspiration,aspiration pneumonia and oropharyngeal discomfort in observation group were significantly fewer than the control group during the ventilator therapy (P<0.05). Conclusions Elaborating nursing intervention can significantly improve the ventilatory function on the patients of chronic obstructive pulmonary disease at acute exacerbation period combined with respiratory failure treated with BiPAP,increase the rate of ventilator tolerance,reduce adverse reactions during the treatment,and help the recovery of the disease.